Models of care for neonatal abstinence syndrome: What works?

Semin Fetal Neonatal Med. 2019 Apr;24(2):121-132. doi: 10.1016/j.siny.2019.01.004. Epub 2019 Jan 29.


Opioid use disorders and the prescription of long-acting medications for their treatment have increased dramatically over the last decade among pregnant women. Newborns who experience prolonged in utero opioid exposure may develop neonatal abstinence syndrome (NAS). Until recently, much of the focus on improving care for NAS has been on pharmacologically-based care models. Recent studies have illustrated the benefits of rooming-in and parental presence on NAS outcomes. Single center Quality Improvement (QI) initiatives demonstrate the benefits of non-pharmacologic care bundles and symptom prioritization in decreasing the proportion of infants pharmacologically treated and length of hospital stay. Little remains known about the impact of these varied cared models on maternal-infant attachment and mental health. In this review article, we will propose an optimal model of care to improve short- and long-term outcomes for newborns, their mothers and families, and perinatal care systems.

Keywords: Baby-centered; ESC; NAS; Neonatal abstinence syndrome; Neonatal opioid withdrawal syndrome; Opioid-withdrawal; Rooming-in; Standardized care; Substance-exposed infants; Trauma-informed care.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / adverse effects*
  • Humans
  • Infant, Newborn
  • Length of Stay
  • Neonatal Abstinence Syndrome / therapy*
  • Perinatal Care / standards*
  • Quality Improvement


  • Analgesics, Opioid