Management of Neonatal Abstinence Syndrome

Breastfeeding #NAS #Neonates

Opioid use and dependency has become a serious problem in the U.S. Research has shown that opioid-dependent women run significantly high risks of giving birth to children with NAS. Children with NAS face some serious health complications, and stay in the hospital longer than normal children. Studies have, however, shown that breastfeeding could help minimize the severity of NAS symptoms among neonates. This text reviews an article seeking to demonstrate how breastfeeding does this, and the specific strategies that nurses and clinicians could use to promote breastfeeding among opioid-dependent mothers in their care.

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Breastfeeding Promotion for Management of Neonatal Abstinence Syndrome (NAS)


The article is focused on one group of at-risk neonates — those whose mothers are opioid-dependent. Research has shown neonates born to opioid-dependent women to run higher risks of developing the Neonatal Abstinence Syndrome (NAS) than those born to non-users. Neonates with NAS display gastrointestinal dysfunction, respiratory distress, central nervous system hyperirritability, and vague autonomic symptoms such as fever, mottled color, sneezing, and yawning. Moreover, compared to their counterparts without the syndrome, such neonates run a higher likelihood of receiving pharmacological treatments with extended hospital stays, which basically translates to higher treatment and upkeep costs. Breastfeeding has been shown to be an effective component of treatment in neonates with NAS. For this reason, the author advocates for the promotion of breast feeding among opioid-dependent women in clinical settings as a way of maximizing the health outcomes of infants with NAS. Breastfeeding encourages maternal-infant bonding, and allows mothers to take an active role in the management of their infants’ withdrawal symptoms. Moreover, the component elements of breast milk provide neonates with passive immunity, thereby shortening the duration of NAS treatment, as well as their duration of stay in the hospital.

The article recommends a number of strategies that clinicians could use to support breastfeeding in their care settings. First, it recommends that clinicians devise effective structured breastfeeding programs and policies to help opioid-dependent mothers understand the benefits of breastfeeding in reducing the severity of NAS symptoms, and to consequently take steps to breastfeed their infants for a minimum of six months. The article also recommends safe bed-sharing (bed in-rooming), pumped breast milk, skin-to-skin contact, and swaddling as strategies for promoting breastfeeding among opioid-dependent mothers. Initiating skin-to-skin contact between mothers and their infants at birth stimulates the release of oxytocin, which creates an immediate intimate relationship between the mother and their child, causing the former to be more likely to breastfeed their infant. Elsewhere, research has shown that one of the reasons why mothers shun from breastfeeding their infants is nipple pain and discomfort –towards this end, the author recommends that nurses and clinicians encourage women who are afraid of breastfeeding to use pumps to provide their neonates with expressed breast milk.

He further proposes that clinicians encourage the use of methadone and buprenoprhine replacement therapies among pregnant opioid-dependent women to minimize their use of opioids. These therapies minimize the risk of NAS in neonates and have not been shown to have any negative effects on infants during breastfeeding. The author concludes that these strategies, combined, would go a long way towards minimizing the risk of NAS in infants, and managing the severity of symptoms among neonates born with the syndrome.

New Insights Learnt and Implications for Nursing Students

There is a lot to learn from the information presented in the reviewed article. I personally learnt a number of crucial new insights from the information presented therein. One of my main learning points was the issue of why women shun from breastfeeding their infants yet we are all aware of the benefits of breast milk to a child’s development. I am aware of the basic reasons for the same such as the fear to feed in public, nipple pain, loss of breast firmness, and inability to produce enough milk; however, I had no idea that a care provider’s failure to initiate proper skin-to-skin contact between a mother and their infant at birth could also be a reason for a mother’s failure to breastfeed. The article mentions that initiating such contact by, for instance, placing the new born on the mother’s abdomen immediately after birth induces maternal parenting behaviors and creates a bond that makes it more likely for the mother to breastfeed. I have seen practitioners and nurses demand that a mother carry their neonate for a while immediately after birth, before they are taken away for cleaning; I, however, have never thought that this bonding may actually be the reason for the same. Well, the information presented in this article teaches me that as a student in this clinical area this semester, I will need to maintain an open mind and view things from multiple perspectives, never assuming that something is done just as a mere formality.

Moreover, the information provides insight on opioid use as one of the elements that place neonates at risk for NAS. This serves as a drive for nursing students such as myself to conduct further research to i) identify and understand other factors apart from opioid use that increase an infants’ chances of developing NAS, and ii) determine other health complications, apart from NAS that place neonates at risk. This article basically will help to expand my knowledge on how to provide effective care for different categories of at-risk neonates.

Implications for Nurses in Nursing Practice

The reviewed article clearly demonstrates that breastfeeding could lessen the severity of NAS in neonates born to opioid-dependent women, and could consequently help to shorten the length of their stay in the hospital. Moreover, it has shown that the use of methadone and buprenoprhine replacement therapies during pregnancy could help minimize such women’s use of opioids, and to consequently minimize the risk of NAS in their neonates. Practicing nurses could incorporate this information into their prenatal and postnatal counseling programs to maximize the health outcomes for at-risk neonates in their care. Moreover, nurses have an obligation to engage in perpetual learning so that they are able to remain relevant in their clinical practice. The information presented in the reviewed article provides a steppingstone for practicing nurses to research and understand other elements or factors that place neonates at risk, and the various care strategies that could be implemented to address the same.


Pritham, U. A. (2013). Breastfeeding Promotion for Management of Neonatal Abstinence Syndrome. Journal of Obstetric, Gynecologic and Neonatal Nursing, 42(5), 517-526.

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