When morphine and/or clonidine are used for pharmacologic treatment in a newborn with neonatal abstinence syndrome (NAS), our consensus-based recommendation is that the newborn be monitored as an inpatient for a minimum of 48 hours after the last dose. A newborn treated with methadone, given the longer half-life, should be monitored as an inpatient for a minimum of 48–72 hours after the last dose of methadone is administered.
Why we are recommending this best practice
Medication clearance in newborns is variable. There are no well-established, evidence-based guidelines for duration of monitoring after pharmacotherapy cessation for NAS.
Strategies for implementation
A recommended observation period after discontinuation of medication should be included in a hospital’s written guidelines.
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- Saarenmaa E, Neuvonen PJ, Rosenberg P, Fellman V. Morphine clearance and effects in newborn infants in relation to gestational age. Clin Pharmacol Ther. 2000;68(2):160-166.
- Lynn AM, Slattery JT. Morphine pharmacokinetics in early infancy. Anesthesiology. 1987;66(2):136-139.
- Wachman EM, Grossman M, Schiff DM, et al. Quality improvement initiative to improve inpatient outcomes for neonatal abstinence syndrome. J Perinatol. 2018;38(8):1114-1122.
- Davis et al. Comparison of safety and efficacy of methadone vs morphine for treatment of neonatal abstinence syndrome: a randomized control trial. JAMA Peds. 2018;172(8).