TY - JOUR
T1 - Reconceptualizing non-pharmacologic approaches to Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS)
T2 - A theoretical and evidence-based approach
AU - Velez, Martha L.
AU - Jordan, Chloe J.
AU - Jansson, Lauren M.
N1 - Funding Information:
The authors have no financial interests or relationships that pose a potential conflict of interest with this article. The preparation of this manuscript was supported by a grant from the National Institute on Drug Abuse of the National Institutes of Health under award number RO1DA0413671 (Jansson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Johns Hopkins University School of Medicine, or McLean Hospital/Harvard Medical School.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Discussions about non-pharmacologic interventions for Neonatal Abstinence Syndrome and Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) have been minor compared with wider attention to pharmacologic treatments. Although historically under-recognized, non-pharmacologic interventions are of paramount importance for all substance-exposed infants and remains as a first line therapy for the care of infants affected by NAS. Here we examine the role of non-pharmacologic interventions for NAS/NOWS by incorporating theoretical perspectives from different disciplines that inform the importance of individualized assessment of the mother-caregiver/infant dyad and interventions that involve both individuals. NAS/NOWS is a complex, highly individualized constellation of signs/symptoms that vary widely in onset, duration, severity, expression, responses to treatment and influence on long-term outcomes. NAS/NOWS often occurs in infants with multiple prenatal/postnatal factors that can compromise neurobiological self-regulatory functioning. We propose to rethink some of the long-held assumptions, beliefs, and paradigms about non-pharmacologic care of the infant with NAS/NOWS, which is provided as non-specific or as “bundled” in current approaches. This paper is Part I of a two-part series on re-conceptualizing non-pharmacologic care for NAS/NOWS as individualized treatment of the dyad. Here, we set the foundation for a new treatment approach grounded in developmental theory and evidence-based observations of infant neurobiology and neurodevelopment. In Part II, we provide actionable, individually tailored evaluations and approaches to non-pharmacologic NAS/NOWS treatment based on measurable domains of infant neurobehavioral functioning.
AB - Discussions about non-pharmacologic interventions for Neonatal Abstinence Syndrome and Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) have been minor compared with wider attention to pharmacologic treatments. Although historically under-recognized, non-pharmacologic interventions are of paramount importance for all substance-exposed infants and remains as a first line therapy for the care of infants affected by NAS. Here we examine the role of non-pharmacologic interventions for NAS/NOWS by incorporating theoretical perspectives from different disciplines that inform the importance of individualized assessment of the mother-caregiver/infant dyad and interventions that involve both individuals. NAS/NOWS is a complex, highly individualized constellation of signs/symptoms that vary widely in onset, duration, severity, expression, responses to treatment and influence on long-term outcomes. NAS/NOWS often occurs in infants with multiple prenatal/postnatal factors that can compromise neurobiological self-regulatory functioning. We propose to rethink some of the long-held assumptions, beliefs, and paradigms about non-pharmacologic care of the infant with NAS/NOWS, which is provided as non-specific or as “bundled” in current approaches. This paper is Part I of a two-part series on re-conceptualizing non-pharmacologic care for NAS/NOWS as individualized treatment of the dyad. Here, we set the foundation for a new treatment approach grounded in developmental theory and evidence-based observations of infant neurobiology and neurodevelopment. In Part II, we provide actionable, individually tailored evaluations and approaches to non-pharmacologic NAS/NOWS treatment based on measurable domains of infant neurobehavioral functioning.
KW - Caregiver
KW - Development
KW - Dyad
KW - Maternal substance use disorder
KW - Neonatal Opioid Withdrawal Syndrome (NOWS)
KW - Neonatal abstinence syndrome (NAS)
KW - Non-pharmacologic care
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U2 - 10.1016/j.ntt.2021.107020
DO - 10.1016/j.ntt.2021.107020
M3 - Article
C2 - 34419619
AN - SCOPUS:85114668841
SN - 0892-0362
VL - 88
JO - Neurotoxicology and Teratology
JF - Neurotoxicology and Teratology
M1 - 107020
ER -