{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T22:37:27Z","timestamp":1757543847314,"version":"3.44.0"},"reference-count":18,"publisher":"The Pediatric Pharmacy Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:sec>\n          <jats:title>OBJECTIVE<\/jats:title>\n          <jats:p>To survey current practices for the treatment of neonatal abstinence syndrome (NAS) among institutions in the United States to identify changes in national practice over time.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>METHODS<\/jats:title>\n          <jats:p>Previous NAS management reports were referenced in the development of our 26-question electronic survey, which was distributed in the fall of 2019 to pediatric practitioners of 2 national clinical pharmacy organizations via email list servers. Not all questions required a response and responses from incomplete surveys were included. Institution demographics and NAS management strategies, including location of care, observation period, and inpatient and outpatient pharmacotherapy, were queried.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>RESULTS<\/jats:title>\n          <jats:p>Seventy respondents representing institutions from all US geographic regions participated in the survey The most commonly reported inpatient observation durations were 3 (18 of 61, 29%) and 5 (22 of 61, 36%) days. Respondents indicated that neonates were typically transferred to the NICU if pharmacologic management was required (38 of 56, 68%). According to participants, first-line agents used for NAS management were morphine (45 of 56, 80%), methadone (5 of 56, 9%), clonidine (2 of 56, 4%), and buprenorphine (2 of 56, 4%). Among respondents, only 20% (11 of 56) reported that infants may be discharged home on pharmacotherapy, including morphine (n = 6), phenobarbital (n = 3), clonidine (n = 1), and methadone (n = 1).<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>CONCLUSIONS<\/jats:title>\n          <jats:p>Opioids are the most commonly used first-line agents for NAS management in the United States. The primary site of NAS management is the inpatient setting, as only 20% of institutions report discharging patients on pharmacotherapy.<\/jats:p>\n        <\/jats:sec>","DOI":"10.5863\/1551-6776-26.6.577","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T20:47:14Z","timestamp":1629146834000},"page":"577-583","source":"Crossref","is-referenced-by-count":3,"title":["Neonatal Abstinence Syndrome Practices in the United States"],"prefix":"10.5863","volume":"26","author":[{"given":"Eva M.","family":"Byerley","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed W.","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlina J.","family":"Grindeland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia D.","family":"Muzzy Williamson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"issue":"1","key":"i1551-6776-26-6-577-b1","series-title":"J Perinatol","first-page":"15","article-title":"Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey","volume":"26","year":"2006","unstructured":"Sarkar\n              S,\n            \n            \n              Donn\n              SM.\n            \n          \n          Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey.\n\t\t\t\t\tJ Perinatol.\n\t\t\t\t\t2006;\n\t\t\t\t\t26(\n\t\t\t\t\t1):\n\t\t\t\t\t15\u2013\n\t\t\t\t\t17."},{"issue":"2","key":"i1551-6776-26-6-577-b2","series-title":"Pediatrics","first-page":"e540","article-title":"Neonatal drug withdrawal","volume":"129","year":"2012","unstructured":"Hudak\n              ML,\n            \n            \n              Tan\n              RC,\n            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Health.\n\t\t\t\t\t2017;\n\t\t\t\t\t22(\n\t\t\t\t\t3):\n\t\t\t\t\t148\u2013\n\t\t\t\t\t152."},{"issue":"3","key":"i1551-6776-26-6-577-b4","series-title":"J Perinatol","first-page":"463","article-title":"Neonatal abstinence syndrome management in California birth hospitals: results of a statewide survey","volume":"40","year":"2020","unstructured":"Clemans-Cope\n              L,\n            \n            \n              Holla\n              N,\n            \n            \n              Lee\n              HC,\n            \n          \n          .\n\t\t\t\t\tNeonatal abstinence syndrome management in California birth hospitals: results of a statewide survey.\n\t\t\t\t\tJ Perinatol.\n\t\t\t\t\t2020;\n\t\t\t\t\t40(\n\t\t\t\t\t3):\n\t\t\t\t\t463\u2013\n\t\t\t\t\t472."},{"issue":"1","key":"i1551-6776-26-6-577-b5","series-title":"J Addict Med","first-page":"75","article-title":"Outcome differences in neonates exposed in-utero to opioids managed in the NICU versus pediatric floor","volume":"13","year":"2019","unstructured":"Lembeck\n              AL,\n            \n            \n              Tuttle\n              D,\n            \n            \n              Locke\n              R,\n            \n          \n          .\n\t\t\t\t\tOutcome differences in neonates exposed in-utero to opioids managed in the NICU versus pediatric floor.\n\t\t\t\t\tJ Addict Med.\n\t\t\t\t\t2019;\n\t\t\t\t\t13(\n\t\t\t\t\t1):\n\t\t\t\t\t75\u2013\n\t\t\t\t\t78."},{"issue":"4","key":"i1551-6776-26-6-577-b6","series-title":"Pediatrics","first-page":"e20173520","article-title":"Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004","volume":"141","year":"2018","unstructured":"Winkelman\n              TNA,\n            \n            \n              Villapiano\n              N,\n            \n            \n              Kozhimannil\n              KB,\n            \n          \n          .\n\t\t\t\t\tIncidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004.\n\t\t\t\t\tPediatrics.\n\t\t\t\t\t2018;\n\t\t\t\t\t141(\n\t\t\t\t\t4):\n\t\t\t\t\te20173520.\n\t\t\t\t\tdoi:10.1542\/peds.2017-3520"},{"key":"i1551-6776-26-6-577-b7","series-title":"J Pediatr","first-page":"151","article-title":"Outpatient pharmacotherapy for neonatal abstinence syndrome","volume":"199","year":"2018","unstructured":"Maalouf\n              FI,\n            \n            \n              Cooper\n              WO,\n            \n            \n              Slaughter\n              JC,\n            \n          \n          .\n\t\t\t\t\tOutpatient pharmacotherapy for neonatal abstinence syndrome.\n\t\t\t\t\tJ Pediatr.\n\t\t\t\t\t2018;\n\t\t\t\t\t199:\n\t\t\t\t\t151\u2013\n\t\t\t\t\t157.e1."},{"key":"i1551-6776-26-6-577-b8","series-title":"J Pediatr","first-page":"185","article-title":"Morphine vs metha-done treatment for infants with neonatal abstinence syndrome","volume":"203","year":"2018","unstructured":"Tolia\n              VN,\n         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trial.\n\t\t\t\t\tJAMA Pediatr.\n\t\t\t\t\t2018;\n\t\t\t\t\t172(\n\t\t\t\t\t8):\n\t\t\t\t\t741\u2013\n\t\t\t\t\t748."},{"issue":"6","key":"i1551-6776-26-6-577-b10","series-title":"Neonatal Netw","first-page":"365","article-title":"Morphine and methadone for neonatal abstinence syndrome: a systematic review","volume":"37","year":"2018","unstructured":"Slowiczek\n              L,\n            \n            \n              Hein\n              DJ,\n            \n            \n              Risoldi Cochrane\n              Z,\n            \n            \n              Gregory\n              PJ.\n            \n          \n          Morphine and methadone for neonatal abstinence syndrome: a systematic review.\n\t\t\t\t\tNeonatal Netw.\n\t\t\t\t\t2018;\n\t\t\t\t\t37(\n\t\t\t\t\t6):\n\t\t\t\t\t365\u2013\n\t\t\t\t\t371."},{"issue":"10","key":"i1551-6776-26-6-577-b11","series-title":"J Paediatr Child Health","first-page":"1177","article-title":"Methadone versus morphine treatment outcomes in neonatal abstinence syndrome: a meta-analysis","volume":"55","year":"2019","unstructured":"Xiao\n              F,\n            \n            \n              Yan\n              K,\n            \n            \n              Zhou\n              W.\n            \n          \n          Methadone versus morphine treatment outcomes in neonatal abstinence syndrome: a meta-analysis.\n\t\t\t\t\tJ Paediatr Child Health.\n\t\t\t\t\t2019;\n\t\t\t\t\t55(\n\t\t\t\t\t10):\n\t\t\t\t\t1177\u2013\n\t\t\t\t\t1182."},{"issue":"3","key":"i1551-6776-26-6-577-b12","series-title":"Pediatrics","first-page":"e601","article-title":"Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial","volume":"122","year":"2008","unstructured":"Kraft\n              WK,\n            \n            \n              Gibson\n              E,\n            \n            \n              Dysart\n              K,\n            \n          \n          .\n\t\t\t\t\tSublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial.\n\t\t\t\t\tPediatrics.\n\t\t\t\t\t2008;\n\t\t\t\t\t122(\n\t\t\t\t\t3):\n\t\t\t\t\te601\u2013\n\t\t\t\t\te607."},{"issue":"4","key":"i1551-6776-26-6-577-b13","series-title":"Am J Perinatol","first-page":"405","article-title":"Comparison of neonatal abstinence syndrome treatment with sublingual buprenorphine versus conventional opioids","volume":"35","year":"2018","unstructured":"Hall\n              ES,\n            \n            \n              Rice\n              WR,\n            \n            \n              Folger\n              AT,\n            \n            \n              Wexelblatt\n              SL.\n            \n          \n          Comparison of neonatal abstinence syndrome treatment with sublingual buprenorphine versus conventional opioids.\n\t\t\t\t\tAm J Perinatol.\n\t\t\t\t\t2018;\n\t\t\t\t\t35(\n\t\t\t\t\t4):\n\t\t\t\t\t405\u2013\n\t\t\t\t\t412."},{"issue":"25","key":"i1551-6776-26-6-577-b14","series-title":"N Engl J Med","first-page":"2468","article-title":"Neonatal abstinence syndrome","volume":"375","year":"2016","unstructured":"McQueen\n              K,\n            \n            \n              Murphy-Oikonen\n              J.\n            \n          \n          Neonatal abstinence syndrome.\n\t\t\t\t\tN Engl J Med.\n\t\t\t\t\t2016;\n\t\t\t\t\t375(\n\t\t\t\t\t25):\n\t\t\t\t\t2468\u2013\n\t\t\t\t\t2479."},{"key":"i1551-6776-26-6-577-b15","series-title":"BMC Pediatr","first-page":"57","article-title":"Phenobarbital versus morphine in the management of neonatal abstinence syndrome, a randomized control trial","volume":"15","year":"2015","unstructured":"Nayeri\n              F,\n            \n            \n              Sheikh\n              M,\n            \n            \n              Kalani\n              M,\n            \n          \n          .\n\t\t\t\t\tPhenobarbital versus morphine in the management of neonatal abstinence syndrome, a randomized control trial.\n\t\t\t\t\tBMC Pediatr.\n\t\t\t\t\t2015;\n\t\t\t\t\t15:\n\t\t\t\t\t57.\n\t\t\t\t\tdoi:10.1186\/s12887-015-0377-9"},{"issue":"4","key":"i1551-6776-26-6-577-b16","series-title":"Ann Pharmacother","first-page":"301","article-title":"Role of clonidine in neonatal abstinence syndrome: a systematic review","volume":"50","year":"2016","unstructured":"Streetz\n              VN,\n            \n            \n              Gildon\n              BL,\n            \n            \n              Thompson\n              DF.\n            \n          \n          Role of clonidine in neonatal abstinence syndrome: a systematic review.\n\t\t\t\t\tAnn Pharmacother.\n\t\t\t\t\t2016;\n\t\t\t\t\t50(\n\t\t\t\t\t4):\n\t\t\t\t\t301\u2013\n\t\t\t\t\t310."},{"issue":"12","key":"i1551-6776-26-6-577-b17","series-title":"J Perinatol","first-page":"954","article-title":"Efficacy of clonidine versus phenobarbital in reducing neonatal morphine sulfate therapy days for neonatal abstinence syndrome: a prospective randomized clinical trial","volume":"33","year":"2013","unstructured":"Surran\n              B,\n            \n            \n              Visintainer\n              P,\n            \n            \n              Chamberlain\n              S,\n            \n          \n          .\n\t\t\t\t\tEfficacy of clonidine versus phenobarbital in reducing neonatal morphine sulfate therapy days for neonatal abstinence syndrome: a prospective randomized clinical trial.\n\t\t\t\t\tJ Perinatol.\n\t\t\t\t\t2013;\n\t\t\t\t\t33(\n\t\t\t\t\t12):\n\t\t\t\t\t954\u2013\n\t\t\t\t\t959."},{"issue":"1","key":"i1551-6776-26-6-577-b18","series-title":"Hosp Pediatr","first-page":"1","article-title":"A novel approach to assessing infants with neonatal abstinence syndrome","volume":"8","year":"2018","unstructured":"Grossman\n              MR,\n            \n            \n              Lipshaw\n              MJ,\n            \n            \n              Osborn\n              RR,\n            \n            \n              Berkwitt\n              AK.\n            \n          \n          A novel approach to assessing infants with neonatal abstinence syndrome.\n\t\t\t\t\tHosp Pediatr.\n\t\t\t\t\t2018;\n\t\t\t\t\t8(\n\t\t\t\t\t1):\n\t\t\t\t\t1\u2013\n\t\t\t\t\t6."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/26\/6\/article-p577.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/jppt\/article-pdf\/26\/6\/577\/2886060\/i1551-6776-26-6-577.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/26\/6\/article-p577.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/26\/6\/article-p577.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:46:50Z","timestamp":1747356410000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/26\/6\/article-p577.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021]]},"references-count":18,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-26.6.577","relation":{},"ISSN":["1551-6776"],"issn-type":[{"type":"print","value":"1551-6776"}],"subject":[],"published":{"date-parts":[[2021]]}}}