30^th European Pediatrics Conference

Neonatal withdrawal or Neonatal Abstinence Syndrome (NAS) is a withdrawal syndrome in Neonates due to acute cessation of the exposure to either illicit or prescribed drugs. Similar to tolerance or dependence, withdrawal may occur as a result of repeated or chronic administration of drugs but also after short-term high dose use like, example., during neonatal stay. Consequently NAS can appear both following discontinuation of drugs taken by the pregnant mother as well as following discontinuation of drugs administered intentionally to the newborn. The most commonly involved compounds are opioids, selective serotonin reuptake inhibitors (SSRIs), benzodiazepines as well as cannabis or nicotine. The incidence of opioid related neonatal abstinence syndrome (NAS) has increased significantly in the last decade, co-linear with the increased medical use of prescription opioids in adults including in young women. The clinical picture of neonatal abstinence syndrome mimics to a large extent the syndrome of opioid withdrawal in adults (‘cold turkey’) and includes both neurological symptoms (e.g. agitation, crying, sleep disturbance, feeding difficulties but also seizures) as well as extra-neurological symptoms (e.g., diarrhea, vomiting, perianal excoriations, sneezing, sweating and hyperthermia). Besides pharmacological interventions, we strongly recommend to consider the impact of other interventions like swaddling, traditional supportive interventions but also breastfeeding since this results in a reduced incidence and severity of NAS (NNT 6-8). This diagnosis is also associated with subsequent impaired neurological outcome.