Pediatrics Group Issues Recommendations on Neonatal Opioid Withdrawal Syndrome

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

NEJM Journal Watch

The American Academy of Pediatrics has issued guidelines on caring for infants with opioid exposure and neonatal opioid withdrawal syndrome.

Among the recommendations, published in Pediatrics:

• Newborns with chronic opioid exposure should be monitored for withdrawal symptoms for at least 72 hours. Those exposed to buprenorphine and sustained-release opioids may need monitoring for 4 to 7 days, and those exposed to methadone, 5 to 7 days.
• Nonpharmacologic interventions (e.g., supportive care) should be the “foundation of care” for all newborns with opioid exposure. For those with severe opioid withdrawal syndrome, treatment with an opioid is recommended.
• Breast-feeding should be supported when women have been in treatment for opioid use disorder (with buprenorphine or methadone) for at least 90 days without relapse. It should be considered for those in treatment for 30 to 90 days without relapse. Breast-feeding should be discouraged when women have active substance use or relapse within the past 30 days.