A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome
Abstract
:1. Introduction
2. Methods
2.1. Search Strategy
2.2. Study Selection
2.3. Data Extraction
- Antenatal screening for neonates at risk;
- Diagnosis of NAS;
- Post-natal care of infants, including non-pharmacological and pharmacological management of NAS;
- Follow-up.
2.4. Quality Assessment of the Evidence Supporting the Guideline Recommendations
Title of Guideline | Country/State of Publication * | Institute | Evidence- or Consensus-Based Grading System | Publication Year | Date for Next Guideline Review |
---|---|---|---|---|---|
National Clinical Guidelines for the management of substance use during pregnancy, birth and the postnatal period [18] | Australia/National | New South Wales (NSW) Ministry of Health | Evidence- and consensus-based—NHMRC | 2014 | Not specified |
Perinatal substance use: neonatal [19] | Australia/Queensland | Queensland Health | Evidence-based ^ | 2021 | September 2026 |
Neonatal Abstinence Syndrome Guidelines [20] | Australia/New South Wales | NSW Ministry of Health | Evidence-based ^ | 2013 | September 2018 † |
Neonatal Abstinence Syndrome (NAS) [21] | Australia/South Australia | SA Health | Evidence- and consensus-based ^ | 2022 | February 2027 |
Substance use during pregnancy—care of the mother and newborn [22] | Australia/Victoria | Safer Care Victoria: Centre of Clinical Excellence | Evidence-based ^ | 2018 | September 2020 † |
Neonatal Abstinence Syndrome [23] | Australia/Western Australia (WA) | Government of Western Australia | Evidence-based ^ | 2020 | February 2023 |
Managing infants born to mothers who have used opioids during pregnancy [24] | Canada | Canadian Paediatric Society (CPS) | Evidence-based ^ | 2018 | Not specified |
Neonatal abstinence syndrome clinical practice guidelines for Ontario [25] | Canada/Ontario | Provincial Council for Maternal and Child Health | Evidence-based—CTFPHC | 2012 | Not specified |
Care of the Newborn Exposed to Substances During Pregnancy [26] | Canada/British Columbia | Perinatal Services BC | Evidence-based ^ | 2020 | Not specified |
Neonatal abstinence syndrome [27] | UK/Scotland | NHS (Greater Glasgow and Clyde) | Evidence-based ^ | 2019 | February 2022 † |
Joint Trust Guideline for the Management of Neonatal Abstinence Syndrome [28] | United Kingdom (UK)/England | NHS (Norfolk and Norwich) | Evidence-based ^ | 2021 | July 2024 |
Neonatal Abstinence Guideline [29] | UK/England | NHS (North Devon) | Evidence-based ^ | 2019 | July 2022 † |
Thames Valley Guideline for Neonatal Abstinence Syndrome [30] | UK/England | NHS (Thames Valley and Wessex) | Evidence-based ^ | 2017 | September 2019 † |
Guideline on the Management of Neonatal Abstinence Syndrome [31] | UK/Wales | National Health Service (NHS) (Wales) | Evidence-based ^ | 2017 | October 2020 † |
Neonatal drug withdrawal [32] | United States of America (USA) | American Academy of Pediatrics (AAP) (Hudak) | Evidence-based ^ | 2012 | May 2021 † |
Neonatal Opioid Withdrawal Syndrome [33] | USA | AAP (Patrick) | Evidence-based ^ | 2020 | November 2025 |
ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015 [34] | USA | American Breastfeeding Medicine (ABM) | Evidence-based ^ | 2015 | April 2020 † |
Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy [35] | USA | American College of Obstetricians and Gynecologists (ACOG) | Evidence-based ^ | 2017 | May 2021—Renewed |
Pregnancy and Opioid Exposure: Guidance for North Carolina [36] | USA/North Carolina | North Carolina Pregnancy and Opioid Exposure Project | Evidence-based ^ | 2015 | Not specified |
Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants [37] | USA | Substance Abuse and Mental Health Services Administration (SAMHSA) | Consensus-based | 2018 | Not specified |
Management of Neonatal Opioid Withdrawal [38] | USA/Vermont | Vermont Department of Health | Evidence-based ^ | 2010 | Not specified |
Guidelines for the identification and management of substance use and substance use disorders in pregnancy [39] | International | World Health Organisation (WHO) | Evidence-based—GRADE system | 2014 | 2019 † |
Guidelines | Recommendations for Treatment | Recommendations for Follow-up | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Antenatal Screening | Toxicology Screening at Birth | Assessment Tool | Breastfeeding if Mother is Stable on OMT and No Transmissible Viruses | Non-Pharmacological Management | Pharmacological Management with Oral Morphine Hydrochloride Dose * | Additional Pharmaceutical Agent as Second Line (e.g., Clonidine, Methadone, Phenobarbitone) | Outpatient Pharmacotherapy | Short-Term Follow-up with GP or Paediatrician (within Specific Time Frame) | Long-Term Follow-up with Development Assessments (within Specific Time Frame) | |
Australia/National [18] | + | + | +Finnegan | + | + | + | + | - | - | - |
Australia/Queensland [19] | + | - | +Finnegan and Eat, Sleep, Console | + | + | +0.125 mg/kg/dose, 6 hourly | + | + | + | + |
Australia/New South Wales [20] | + | + | +Finnegan | + | + | +0.125 mg/kg/dose, 6 hourly | + | + | + | - |
Australia/South Australia [21] | + | + | +Finnegan | + | + | + 0.1 mg/kg/dose, 4 hourly | + | + | + | - |
Australia/Victoria [22] | + | + | +Finnegan | + | + | + 0.125 mg/kg/dose, 6 hourly | + | + | + | - |
Australia/Western Australia [23] | + | - | +Finnegan | + | + | +0.125 mg/kg/dose, 6 hourly | + | + | - | - |
Canada/CPS [24] | + | + | +Finnegan | + | + | + 0.05 mg/kg/dose, 6 hourly | + | + | - | - |
Canada/Ontario [25] | + | + | +Finnegan | + | + | + 0.05 mg/kg/dose, 6 hourly | + | + | - | - |
Canada/Perinatal BC [26] | + | + | +Eat, Sleep, Console | + | - | + 0.04 mg/kg/dose, 4 hourly | - | - | - | - |
United Kingdom (UK)/Greater Glasgow and Clyde [27] | + | + | +Lipsitz | + | + | + 0.06 mg/kg/dose, 4 hourly | + | - | - | - |
United Kingdom (UK)/Norfolk and Norwich [28] | - | + | +Lipsitz | + | + | + 0.05 mg/kg/dose, 4 hourly | + | + | - | - |
United Kingdom (UK)/North Devon [29] | + | - | +Own system | + | + | + 0.04 mg/kg/dose, 4 hourly | + | + | - | - |
United Kingdom (UK)/Thames Valley and Wessex [30] | + | - | +Own system | + | + | + 0.04 mg/kg/dose, 4 hourly | + | + | - | - |
United Kingdom (UK)/Wales [31] | + | + | +Lipsitz | + | + | + 0.06 mg/kg/dose, 4 hourly | + | - | - | - |
USA/AAP (Hudak, 2012) [32] | + | - | + | + | + | + 0.04 mg/kg/dose, 3–4 hourly | + | + | - | - |
USA/AAP (Patrick, 2020) [33] | + | + | + | + | + | + | + | - | + | |
USA/ABM [34] | + | + | + | - | - | - | - | - | - | |
USA/ACOG [35] | + | +Finnegan | + | - | - | - | - | - | - | |
USA/North Carolina [36] | - | +Finnegan | + | + | + | - | + | + | - | |
USA/SAMHSA [37] | + | + | + | + | + | + | + | + | - | |
USA/Vermont [38] | - | +Finnegan | + | + | + 0.04 mg, 3–4 hourly | - | + | + | - | |
International/WHO [39] | + | + | + | + | + | + | - | - | - |
3. Results
3.1. Summary of Recommendations
3.1.1. Antenatal and Toxicology Screening
3.1.2. Diagnosis
3.1.3. Management
3.1.4. Follow-Up
3.2. Quality Appraisal and Inter-Rater Reliability
3.2.1. Domain 1: Scope and Purpose
3.2.2. Domain 2: Stakeholder Involvement
3.2.3. Domain 3: Rigour of Development
3.2.4. Domain 4: Clarity of Presentation
3.2.5. Domain 5: Applicability
3.2.6. Domain 6: Editorial Independence
3.3. Summary of Evaluation
4. Discussion
4.1. Recommendations for Clinical Diagnosis
4.2. Recommendations for Management
4.3. Guideline Quality Appraisal
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Country of Origin | Author | Scaled Score Percentage (%) | Overall Recommendation | |||||
---|---|---|---|---|---|---|---|---|
1. Scope and Purpose | 2. Stakeholder Involvement | 3. Rigour of Development | 4. Clarity of Presentation | 5. Applicability | 6. Editorial Independence | |||
Australia | National [18] | 81 | 78 | 51 | 94 | 57 | 30 | Y with M |
Queensland Health [19] | 33 | 72 | 42 | 96 | 26 | 16 | N | |
New South Wales Health [20] | 72 | 37 | 37 | 63 | 32 | 0 | N | |
South Australia Government [21] | 81 | 46 | 21 | 94 | 36 | 0 | N | |
Victorian Government [22] | 57 | 1 | 13 | 78 | 11 | 0 | N | |
Western Australia Health [23] | 39 | 30 | 28 | 65 | 31 | 0 | N | |
Canada | CPS [24] | 70 | 39 | 34 | 65 | 17 | 22 | N |
Ontario [25] | 87 | 24 | 45 | 94 | 67 | 0 | Y with M | |
Perinatal BC [26] | 54 | 11 | 26 | 87 | 54 | 0 | N | |
United Kingdom | NHS/Greater Glasgow and Clyde [27] | 59 | 52 | 17 | 85 | 18 | 0 | N |
NHS/Norfolk and Norwich [28] | 48 | 56 | 38 | 70 | 31 | 0 | N | |
NHS/North Devon [29] | 85 | 13 | 24 | 70 | 40 | 0 | N | |
NHS/Thames Valley and Wessex [30] | 91 | 44 | 27 | 94 | 35 | 0 | N | |
NHS/Wales [31] | 43 | 0 | 1 | 59 | 19 | 0 | N | |
United States of America | AAP (Hudak, 2012) [32] | 80 | 24 | 40 | 93 | 17 | 70 | Y with M |
AAP (Patrick, 2020) [33] | 91 | 17 | 38 | 96 | 36 | 100 | Y with M | |
ABM [34] | 70 | 20 | 41 | 85 | 15 | 24 | N | |
ACOG [35] | 74 | 37 | 31 | 78 | 32 | 0 | N | |
North Carolina [36] | 91 | 17 | 20 | 72 | 36 | 0 | N | |
SAMHSA [37] | 72 | 63 | 56 | 98 | 43 | 19 | Y with M | |
Vermont [38] | 63 | 39 | 12 | 78 | 49 | 35 | N | |
International | WHO [39] | 94 | 96 | 88 | 100 | 43 | 73 | Y |
Median Domain score ± SD | 72 ± 18 | 37 ± 25 | 33 ± 18 | 85 ± 13 | 34 ± 15 | 0 ± 29 |
Guideline | ICC | 95% CI |
---|---|---|
Australia | ||
National [18] | 0.975 | 0.950–0.989 |
Queensland [19] | 0.977 | 0.954–0.990 |
New South Wales [20] | 0.981 | 0.961–0.991 |
South Australia [21] | 0.964 | 0.927–0.983 |
Victoria [22] | 0.968 | 0.935–0.985 |
Western Australia [23] | 0.955 | 0.910–0.979 |
Canada | ||
CPS [24] | 0.902 | 0.805–0.955 |
Ontario [25] | 0.982 | 0.964–0.992 |
British Columbia [26] | 0.982 | 0.965–0.992 |
United Kingdom | ||
Greater Glasgow and Clyde [27] | 0.972 | 0.959–0.991 |
Norfolk and Norwich [28] | 0.918 | 0.836–0.963 |
North Devon [29] | 0.981 | 0.962–0.991 |
Thames Valley and Wessex [30] | 0.952 | 0.904–0.978 |
Wales [31] | 0.956 | 0.913–0.980 |
United States of America | ||
AAP (Hudak, 2012) [32] | 0.973 | 0.946–0.988 |
AAP (Patrick, 2020) [33] | 0.974 | 0.947–0.988 |
ABM [34] | 0.943 | 0.886–0.974 |
ACOG [35] | 0.950 | 0.900–0.977 |
North Carolina [36] | 0.984 | 0.967–0.992 |
SAMHSA [37] | 0.984 | 0.967–0.992 |
Vermont [38] | 0.929 | 0.858–0.968 |
International | ||
World Health Organisation [39] | 0.988 | 0.976–0.995 |
Domain | ICC | 95% CI |
---|---|---|
1 | 0.947 | 0.920–0.966 |
2 | 0.974 | 0.961–0.983 |
3 | 0.958 | 0.946–0.968 |
4 | 0.926 | 0.889–0.953 |
5 | 0.940 | 0.915–0.959 |
6 | 0.983 | 0.972–0.990 |
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Wei, Z.; Gilbert, Y.; Thananjeyan, A.; Cope, J.; Morton, R.L.; Li, A.; Pham, C.T.; Ward, M.; Oei, J.L. A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome. Children 2023, 10, 1685. https://doi.org/10.3390/children10101685
Wei Z, Gilbert Y, Thananjeyan A, Cope J, Morton RL, Li A, Pham CT, Ward M, Oei JL. A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome. Children. 2023; 10(10):1685. https://doi.org/10.3390/children10101685
Chicago/Turabian StyleWei, Zoe, Yasmin Gilbert, Arabhi Thananjeyan, James Cope, Rachael L. Morton, Annie Li, Cecile T. Pham, Meredith Ward, and Ju Lee Oei. 2023. "A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome" Children 10, no. 10: 1685. https://doi.org/10.3390/children10101685
APA StyleWei, Z., Gilbert, Y., Thananjeyan, A., Cope, J., Morton, R. L., Li, A., Pham, C. T., Ward, M., & Oei, J. L. (2023). A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome. Children, 10(10), 1685. https://doi.org/10.3390/children10101685