{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T22:26:46Z","timestamp":1781130406453,"version":"3.54.1"},"reference-count":64,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,7,2]],"date-time":"2017-07-02T00:00:00Z","timestamp":1498953600000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100002661","name":"Fonds De La Recherche Scientifique - FNRS","doi-asserted-by":"publisher","award":["1800214N"],"award-info":[{"award-number":["1800214N"]}],"id":[{"id":"10.13039\/501100002661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003132","name":"Agentschap voor Innovatie door Wetenschap en Technologie","doi-asserted-by":"publisher","award":["IWT\/SBO 130033"],"award-info":[{"award-number":["IWT\/SBO 130033"]}],"id":[{"id":"10.13039\/501100003132","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:p>\n                    Substance use among pregnant women is a major public health issue. Both prescription opioid use and illicit opioid abuse have increased dramatically in recent years. Prolonged in utero drug exposure may result in neonatal abstinence syndrome (\n                    <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content>\n                    ), an acute multisystemic clinical entity that occurs in the first days of life. This syndrome is caused by abrupt discontinuation of fetal exposure to licit or illicit drugs chronically consumed by the mother during pregnancy and transmitted to the fetus through the placenta. It usually requires prolonged hospitalization and may have long\u2010term effects. The interplay of many factors contributes to its clinical heterogeneity, and its pathophysiology has not been fully unveiled. The first step in\n                    <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content>\n                    management consists of nonpharmacologic interventions and includes promoting breastfeeding when not contraindicated. If withdrawal signs become severe, pharmacotherapy is needed. The Finnegan scoring system supports care providers across the pharmacotherapy process from initiation through the monitoring phase, until weaning and discontinuation. However, a standardized approach to pharmacotherapy is still lacking. Morphine is usually the first\u2010line agent to treat\n                    <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content>\n                    . Methadone is a valid option, but its safety profile is not completely known. Phenobarbital, despite its lack of effect on gastrointestinal symptoms and unfavorable pharmacologic features, has been identified as a second\u2010line agent to be used in infants unresponsive to opiates. Although buprenorphine and clonidine seem promising, their use requires further validation. Long\u2010term developmental effects of\n                    <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content>\n                    therapy call for more\u2010comprehensive, longitudinal assessments. In this article, key points for use of recommended therapies are outlined, and directions for future research are suggested.\n                  <\/jats:p>","DOI":"10.1002\/phar.1954","type":"journal-article","created":{"date-parts":[[2017,5,18]],"date-time":"2017-05-18T11:56:26Z","timestamp":1495108586000},"page":"814-823","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Neonatal Abstinence Syndrome: Update on Diagnostic and Therapeutic Strategies"],"prefix":"10.1002","volume":"37","author":[{"given":"Genny","family":"Raffaeli","sequence":"first","affiliation":[{"name":"NICU Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4921-1437","authenticated-orcid":false,"given":"Giacomo","family":"Cavallaro","sequence":"additional","affiliation":[{"name":"NICU Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Allegaert","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration KU Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enno Diederik","family":"Wildschut","sequence":"additional","affiliation":[{"name":"Intensive Care and Department of Pediatric Surgery Erasmus MC\u2010Sophia Children's Hospital Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Fumagalli","sequence":"additional","affiliation":[{"name":"NICU Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Agosti","sequence":"additional","affiliation":[{"name":"NICU Del Ponte Hospital Varese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dick","family":"Tibboel","sequence":"additional","affiliation":[{"name":"Intensive Care and Department of Pediatric Surgery Erasmus MC\u2010Sophia Children's Hospital Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Mosca","sequence":"additional","affiliation":[{"name":"NICU Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Universit\u00e0 degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,2]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"141","article-title":"Neonatal abstinence syndrome: assessment and management","volume":"1","author":"Finnegan L","year":"1974","journal-title":"Addict Dis"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)82214-0"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.61.12.1236"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1038\/sj.jp.7211378","article-title":"Low birth weight and preterm births: etiologic fraction attributable to prenatal drug exposure","volume":"10","author":"Bada HS","year":"2005","journal-title":"J Perinatol"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1500439"},{"key":"e_1_2_11_7_1","unstructured":"Abuse Mental Health Services Administration.Results from the 2012 national survey on drug use and health: summary of national findings. 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