Family-Centered Care Approaches for Neonatal Abstinence Syndrome: Caring for Mothers and Infants

Neonatal abstinence syndrome (NAS) is a variable, complex, and incompletely understood spectrum of neonatal neurobehavioral dysregulation associated with prenatal drug exposure, most commonly opioids. Research on short- and long-term neurodevelopmental consequences of NAS is limited, and results are often confounded by polysubstance use during pregnancy (licit and illicit), prenatal care and nutrition, and medical complications, as well as ongoing exposure to environmental risks, including poverty and the quality of the caregiving environment. However, neonatal outcomes including symptom severity, need for and length of pharmacotherapy, and length of stay, may also be associated with the approach to screening and treatment of NAS symptoms. Although nonpharmacological care is the recommended first-line approach, there is no standardized procedure for NAS management or initiation of pharmacotherapy, and a wide range (27–91%) of neonates with NAS receive pharmacological interventions. Nonpharmacological treatments vary greatly in documented efficacy and include methods of “supportive care,” such as providing close relational experiences; swaddling; quiet, low-stimulation environment; and use of pacifiers. Recent research has suggested that family-centered NAS treatment approaches, such as rooming-in and the Eat, Sleep, Console (ESC) model, are associated with shorter lengths of stay and reduced need for pharmacotherapy, as well as increased rates of breastfeeding, skin-to-skin contact, and improved quality of caregiving and attachment. Together these outcomes are associated with better neurodevelopmental outcomes. Thus, family-centered approaches and treatment programs that keep mothers and infants together may be key to reducing morbidity and improving long-term outcomes for substance-exposed infants and their families.