Journal of Neonatal Nursing xxx (xxxx) xxx

Contents lists available at ScienceDirect

Journal of Neonatal Nursing

journal homepage: www.elsevier.com/locate/jnn

Neonatal Abstinence Syndrome and non-pharmacological nursing care. A

scoping review
María Paula Castañeda Sandoval a, Daniel Fernando González Gonzalez a,
Kelly Johanna Peña Suarez a, Diego Fernando Rosero Medina a, *, Dolly Arias Torres b,
Juan Camilo Calderón Farfán a
a
Nursing Department, Universidad Surcolombiana, Neiva, Colombia
b
Doctor in Health Sciences, Universidad Surcolombiana, Neiva, Colombia

A R T I C L E I N F O A B S T R A C T

Handling Editor: Ms L Altimier Background: Neonatal Abstinence Syndrome refers to the signs and symptoms experienced by newborn infants
when they are no longer exposed to substances, drugs, or narcotics their mothers used during pregnancy.
Keywords: Objective: To characterize the non-pharmacological nursing care provided to newborn infants with Neonatal
Neonatal abstinence syndrome Abstinence Syndrome.
Nursing care
Methods: Descriptive study using a scoping review of the literature. Five databases were searched for original
Non-pharmacological treatment
articles published between 2016 and 2021 on the nursing care of newborns with NAS. Following the Preferred
Infant
Newborn Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, nine articles were selected for
Diseases the qualitative synthesis.
Neonatal nursing Results: Different non-pharmacological care interventions for newborns with NAS were identified and grouped
Nursing research into five categories.
Nurses Conclusion: Non-pharmacological nursing care for newborns with NAS addresses feeding methods, environmental
Neonatal control, alternating therapies, and soothing techniques. These care options are essential to developing appro­
priate nursing care plans for these subjects of care.

1. Introduction
Neonatal Abstinence Syndrome (NAS) refers to the signs and symp­
toms experienced by newborn infants when they are no longer exposed
to substances, drugs, or narcotics their mothers used during pregnancy
(Mellado et al., 2008). This syndrome encompasses a wide range of
neurological, cardiovascular, gastrointestinal, and musculoskeletal dis­
orders associated with withdrawal from exposure to any addictive
substance(Zapata Diaz et al., 2017), including opioids, hallucinogens,
barbiturates, benzodiazepine, chlordiazepoxide, methylphenidate,
alcohol, pentazocine, and others(Sierra et al., 2008). Prolonged expo­
sure to opioids during pregnancy is associated with a specific condition
known as Neonatal Opioid Withdrawal Syndrome (NOWS), which refers
to withdrawal symptoms that occur as a newborn’s body adjusts to the
absence of opioids after birth (Mangat et al., 2019).
The increase in the use of psychoactive substances is currently a
public health problem affecting millions of people worldwide.
Particularly in the United States, the opioid crisis has witnessed a sig­
nificant surge, leading to a substantial rise in NOWS cases. Conse­
quently, a diverse range of non-pharmacological treatments is now
imperative to ensure healthy neonatal outcomes (Jackson et al., 2020).
According to the United Nations Office on Drugs and Crime (UNODC)
World Drug Report, about 284 million people, or 5.6% of the population
aged 15–64, used some form of drug at least once in 2020; an increase of
11% is expected by 2030(United Nations Office On Drugs and Crime
(UNODC), 2022). About 192 million people used cannabis in 2018,
making it the world’s most-used drug, particularly in Latin America,
according to the Inter-American Drug Abuse Control Commission
(CICAD, for its acronym in Spanish) (Comisión Interamericana para el
Control de Drogas (CICAD), 2019).
In South America, the countries reporting the highest rates of abuse
of psychoactive substances are Chile (14.5%), Argentina, and Uruguay
(10%) (Comisión Interamericana para el Control de Drogas (CICAD),
2019). In Colombia, according to the 2019 National Survey of Psycho­
active Substances Consumption, an estimated 2.3 million people

* Corresponding author. Calle 9 No. 15-25, Neiva, Colombia.

E-mail addresses: diego.rosero@usco.edu.co, diegorosero.medina@hotmail.com (D.F. Rosero Medina), juan.calderon@usco.edu.co (J.C. Calderón Farfán).

https://doi.org/10.1016/j.jnn.2023.07.015
Received 15 May 2023; Received in revised form 13 July 2023; Accepted 25 July 2023
Available online 31 July 2023
1355-1841/© 2023 The Authors. Published by Elsevier Ltd on behalf of Neonatal Nurses Association. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article as: María Paula Castañeda Sandoval et al., Journal of Neonatal Nursing, https://doi.org/10.1016/j.jnn.2023.07.015
M.P. Castañeda Sandoval et al.
Acronyms and abbreviations
•NAS Neonatal Abstinence Syndrome
•NOWS Neonatal Opioid Withdrawal Syndrome
•CNS Central Nervous Systems
between the ages of 12 and 65 have used illicit substances at some point
in their lives; 33% have smoked tobacco or cigarettes; 84% have
consumed alcoholic beverages, and 9.7% have used cannabis (mari­
juana), or heroin (Archivo Nacional de Datos, 2020).
In response to the increasing use of psychoactive substances,
Colombia has developed policies and guidelines to prevent the occa­
sional or continuous use of such substances from a health promotion
perspective. The Ten-year Public Health Plan 2022–2031 proposes
strategies for the comprehensive management of the use of psychoactive
substances in its fourth strategic axis, “comprehensive public health risk
management.“(Ministerio de Salud y Protección Social, 2022) Resolu­
tion 089 of 2019 establishes the Comprehensive Policy for the Preven­
tion and Care of Psychoactive Substances Use, which seeks to strengthen
protective factors to achieve optimum health and well-being for the
population (Ministerio de Salud y Protección Social, 2019).
Moreover, the Law 1385 of 2010 establishes measures to prevent
fetal alcohol syndrome due to alcohol consumption by pregnant women
(Congreso de la República de Colombia, 2021). On the other hand, Law
1566 of 2012 recognizes that use, abuse, and dependence on psycho­
active substances, whether licit or illicit, is a public health and welfare
issue for families, communities, and individuals. Likewise, this law es­
tablishes rules to ensure comprehensive care for people who use these
substances (Congreso de la República de Colombia, 2016).
Since the onset of the COVID-19 pandemic, an increase in the use of
drugs such as cannabis has been observed. There is also evidence that
consumption habits may have become more harmful while access to
substance abuse services has decreased, disproportionately affecting
female drug users (United Nations Office On Drugs and Crime (UNODC),
2022).
A gender treatment gap was observed in 2020, a particularly serious
issue for women worldwide. Regarding drug use, the majority of drug
users are men. According to estimates, most female drug users are of
childbearing age; therefore, unplanned pregnancy poses this group at
risk of prenatal drug exposure (United Nations Office On Drugs and
Crime (UNODC), 2022).
The prenatal effects of drug use on infants include premature birth,
teratogenesis, and delayed fetal development. Persistent and uncon­
trolled sucking problems, anthropometric measurements and head
circumference decrease, stroke predisposition, cognitive or behavioral
difficulties, learning or socialization difficulties, aggression and hyper­
activity episodes, delayed development, and neuronal excitability are
some of the postnatal effects of drug use on newborn infants (Menéndez
García et al., 2018).
Considering the consequences of using addictive substances by
pregnant women, they become a field of action for nursing care.
Through direct and permanent interaction and comprehensive assess­
ment, nurses can formulate appropriate care plans to improve the
quality of life for newborn infants and their mothers. Currently, few
studies mention non-pharmacological nursing care for newborns with
NAS. Therefore, this scoping review aimed to describe the non-
pharmacological nursing care for newborn infants with NAS.
2. Methods
This descriptive study uses a scoping review of original articles
published in scientific journals. The study focused on describing non-
pharmacological nursing care options for newborns with NAS.
2
Journal of Neonatal Nursing xxx (xxxx) xxx
Full text of original research articles on non-pharmacological nursing
care of newborns with NAS, written in English or Spanish and published
in scientific journals between 2016 and 2021, were included in the re­
view. Gray literature, literature reviews, and documents that did not
contribute to the objectives of this study were excluded.
Data were collected following the stages proposed by Arksey and
O’Malley to map the key concepts and the main sources and types of
evidence available (Arksey and O’Malley, 2005). Their methodological
framework includes five stages: 1) identifying the research question, 2)
identifying relevant studies, 3) study selection, 4) tabulating the data,
and 5) reporting the results.
The first stage involved phrasing the research question: What are the
non-pharmacological nursing care options recommended for newborns
suffering from NAS?
The second stage involved identifying relevant studies and selecting
the population, which consisted of original research found in Science­
Direct, PubMed, Virtual Health Library, Wiley Online Library, and
Taylor & Francis databases.
The third stage (study selection) was conducted using Health Sci­
ences Descriptors (DeCS) and Medical Subject Headings (MeSH). A
search strategy was developed using Boolean operators AND, OR, and
NOT to retrieve relevant articles for the study. The use of search filters
was based on the previously defined inclusion criteria. Studies were
selected following the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) statement. First, each researcher inde­
pendently screened titles, resulting in 57 articles that were selected to be
screened. Then, titles and abstracts were screened, and 15 articles were
selected for eligibility assessment. Finally, after the eligibility assess­
ment of the full texts, nine articles that met the study’s objectives were
included in the review.
In the fourth stage, each article was carefully read and analyzed to
collect and register the data using a database created in Microsoft Excel.
The data were organized by author, title, publication year, the country
where the study was conducted, language, study design, population,
sample, sampling method, and data collection techniques. Additional
columns were added to register information about the most commonly
used substances, clinical manifestations, nursing care, care outcomes,
conclusions, recommendations, and observations. Data not found in the
reviewed articles were registered as “Not reported”. Interventions
related to the nursing care of newborns with NAS were identified and
classified into the following categories: Environmental control, feeding
methods, social integration, therapeutic modalities, and soothing tech­
niques. Data on substances and clinical manifestations of NAS were also
tabulated.
Finally, in the fifth stage, the results were reported using tables and
graphs based on the thematic axes previously defined, according to the
objectives and variables of the study. Significant findings were high­
lighted through comparisons between obtained results.
2.1. Ethical considerations
Considering that the study involved a review of secondary sources, it
did not require approval from the Ethics Committee. In this study, the
researchers declare that they applied a higher accuracy when searching
for information.
3. Results
Based on the search strategy used (see Table 1), quantitative and
qualitative studies were found. The most common sampling method
used was convenience sampling. For data collection, interviews and
surveys were the most common methods used.
Three of the 596 articles found were discarded because they were
duplicates. After applying search filters, 57 articles were selected to read
titles and abstracts, of which nine were selected for qualitative synthesis.
The results of each step of the article selection process are presented in
M.P. Castañeda Sandoval et al. Journal of Neonatal Nursing xxx (xxxx) xxx

Table 1 women in the articles reviewed were classified into three groups
Search strategies used in the different databases. accordingly (Menéndez García et al., 2018): Central Nervous Systems
Databases DecS-Mesh (CNS) depressants, such as opioids, codeine, morphine, buprenorphine,
methadone, oxycodone, fentanyl, barbiturates, benzodiazepines, heroin,
PubMed “Neonatal Abstinence Syndrome” OR “Neonatal Withdrawal
Syndrome” AND “Nursing Care” and alcohol (Clemans-Cope et al., 2020; Hignell et al., 2020; M. Holmes
Virtual Health “Neonatal Abstinence Syndrome” AND “Nursing Care” NOT et al., 2019; Jackson et al., 2020; MacMullen and Samson, 2018);
Library “Pharmacological Actions” stimulants such as cocaine, amphetamines, and tobacco(MacMullen and
ScienceDirect “Neonatal Abstinence Syndrome” AND “Infant Care” OR Samson, 2018), and hallucinogens, such as marijuana (Jackson et al.,
“Nursing Care”
Wiley Online “Neonatal Abstinence Syndrome” AND “Nursing Care” NOT
2020).
Library “Pharmacological Actions” Based on the articles reviewed (see Table 2), the main clinical
Taylor & Francis (Neonatal Abstinence Syndrome) AND (Nursing Care) AND manifestations of NAS in newborn infants were identified, with CNS
(Nonpharmacological) disorders being predominant. Irritability, nervousness, tremors, exces­
sive crying, agitation, hypotonia, and sweating are other clinical mani­
festations of NAS. Cardiorespiratory and gastrointestinal disorders were
the flow diagram (see Fig. 1).
also identified, but less frequently.
The articles selected were published between 2018 and 2021, with
Regarding non-pharmacological nursing care, five categories of care
predominant number published in 2019. Most of the articles originated
were identified, which are described below:
from Canada, Australia, and the United States, in that order, and were
Feeding methods: Lactation is the preferred method of feeding
written in English.
(Clemans-Cope et al., 2020; Jackson et al., 2020; MacMullen and
The psychoactive substances most commonly used by pregnant

Fig. 1. PRISMA flowchart of the review.

3
M.P. Castañeda Sandoval et al. Journal of Neonatal Nursing xxx (xxxx) xxx

Table 2 facing away from the infant, C positioning, swaddling, vertical rocking,
Reviewed articles on Neonatal Abstinence Syndrome (NAS). continuous butt patting, cuddling, and making “shhing” sounds are
Authors Article Title Year mentioned (Maguire et al., 2018). These non-pharmacological nursing
care interventions to manage NAS are summarized in Table 3.
Hignell A, Carlyle K, Bishop C, The Infant Cuddler Study: Evaluating 2019
Murphy M, Valenzano T, Turner the effectiveness of volunteer
S, and Sgro M. cuddling in infants with neonatal 4. Discussion
abstinence syndrome
Shannon J, Blythe S, and Peters K. The Complexities Associated with 2021 Nurses play a crucial role in the management of NAS, particularly
Caring for Hospitalised Infants with
Neonatal Abstinence Syndrome: The
concerning non-pharmacological care aimed at reducing withdrawal
Perspectives of Nurses and Midwives signs and symptoms and improving clinical status (Adrian, 2019).
Shannon J, Peters K, and Blythe S. The Challenges to Promoting 2021 Addictive substances, especially opioids and opiate derivatives, have
Attachment for Hospitalised Infants an impact on maternal-fetal health, affecting the CNS and requiring
with NAS
specific treatments. Withdrawal symptoms are clinically recognizable in
Clemans-Cope L, Holla N, Lee HC, Neonatal abstinence syndrome 2020
Cong AS, Castro R, Chyi L, management in California birth 60%–80% of newborns exposed to drugs (McLemore et al., 2013)
Huang A, Taylor KJ, and Kenney hospitals: results of a statewide because they cause CNS hyperexcitability (Pomar et al., 2017). While
GM. survey NOWS is specifically linked to intrauterine exposure to opioids, NAS can
Holmes M and Wright M. Survey of Neonatal Intensive Care 2019 also be associated with the use of other substances like as methylphe­
Unit Nurses’ Use of a Motion/Sound
Infant Seat
nidate, pentazocine, alcohol, and tobacco (Sierra et al., 2008).
Maguire DJ, Shaffer-Hudkins E, Feeding Infants with Neonatal 2018 Pathophysiology and clinical manifestations of NAS vary depending
Armstrong K, and Clark L. Abstinence Syndrome: Finding the on the substances used by the mother; however, common symptom­
Sweet Spot atology includes tremors, irritability, agitation, sleeping disturbances,
Minear S and Wachman EM. Management of Newborns with 2019
diarrhea, excessive crying, and seizures (Kocherlakota, 2014). The most
Prenatal Opioid Exposure: One
Institution’s Journey common CNS signs of NAS include hyperirritability, jitteriness, sleep
MacMullen NJ and Samson LF. Neonatal Abstinence Syndrome: An 2018 disturbance, and inconsolable crying (M. Holmes et al., 2019).
Uncontrollable Epidemic In the autonomic nervous system, NAS often manifests as alterations
Jackson HJ, Lopez C, Miller S, and Feasibility of auricular acupressure as 2020 in muscle tone with either an increase or decrease observed, along with
Englehardt B. an adjunct treatment for neonatal
temperature regulation instability (sudden hyperthermia or hypother­
opioid withdrawal syndrome
(NOWS) mia) (Jackson et al., 2020; MacMullen and Samson, 2018; Minear and
Wachman, 2019). Gastrointestinal signs of NAS include vomiting,
diarrhea, feeding difficulties, and general gastrointestinal distress
Samson, 2018; Minear and Wachman, 2019), as long as the mother
abstains from using substances such as alcohol, illicit drugs, and am­
phetamines (Clemans-Cope et al., 2020; Maguire et al., 2018). Nursing Table 3
care encompasses providing assistance with nutritional needs, offering Non-pharmacological nursing care for managing Neonatal Abstinence Syndrome
(NAS).
guidance on appropriate feeding practices and recommended serving
sizes and not overfeeding the infant or giving extra snacks every time the Categories Care type Authors
infant cries. Feeding methods Lactation Clemans-Cope et al. (2020).
Environmental control: The importance of a quiet and comfortable MacMullen and Samson
environment is highlighted. Reducing negative stimuli such as loud (2018).
Minear and Wachman
noises, bright lighting, or any other environmental factor that may stress
(2019).
the infant is strongly recommended (Clemans-Cope et al., 2020). The use Ministerio de Salud y
of open cribs and ensuring comfortable sleeping positions are also Protección Social, 2019.
mentioned as beneficial practices, as they facilitate longer periods of Abstaining from using Clemans-Cope et al. (2020)
sleep and extended naps (Minear and Wachman, 2019). drugs Jackson et al. (2020)
MacMullen and Samson
Social integration: Social integration includes skin-to-skin contact, (2018)
rooming-in, and promoting maternal-infant bonding. Cuddling and Maguire et al. (2018)
holding the infant swaddled and close to the chest so they can perceive Shannon et al. (2021)
smells and hear heartbeats or natural sounds, both from their parents Nutrition care Shannon et al. (2021)
Environmental control Reduction of external Clemans-Cope et al. (2020)
and the nursing staff, are some nursing care practices that promote and
negative stimuli.
facilitate bonding (Clemans-Cope et al., 2020; Jackson et al., 2020; Comfort for sleeping Minear and Wachman
Maguire et al., 2018; Shannon et al., 2021; Shannon et al., 2021). (2019)
Similarly, keeping the infant and the mother together during childbirth Social Integration Promoting bonding Clemans-Cope et al. (2020)
or postpartum hospitalization (rooming-in care) is mentioned as a way Hignell et al. (2020)
Holmes et al. (2019)
to strengthen the mother-infant bond (MacMullen and Samson, 2018; Jackson et al. (2020)
Minear and Wachman, 2019). Maguire et al. (2018)
Alternating therapeutic modalities: This category includes combining Shannon et al. (2021)
auricular acupressure with other standard non-pharmacological mo­ Shannon et al. (2021)
Rooming-in MacMullen and Samson
dalities for 72 h (Jackson et al., 2020); acupuncture and laser
(2018)
acupuncture in the infants’ external ear, as a complimentary therapy to Minear and Wachman
stochastic vibrotactile stimulation (Clemans-Cope et al., 2020; Mac­ (2019)
Mullen and Samson, 2018). Alternating therapeutic Acupressure and Clemans-Cope et al. (2020)
Soothing techniques: Vibrotactile stimulation in alternating cycles of 6 modalities acupuncture Jackson et al. (2020)
MacMullen and Samson
and 8 hours(MacMullen and Samson, 2018), holding, swaddling, com­ (2018)
forting, rocking, gentle rubbing, and using pacifiers are the commonly Soothing techniques Vibrotactile stimulation MacMullen and Samson
used soothing techniques (Clemans-Cope et al., 2020; Jackson et al., (2018)
2020). Interventions such as avoiding eye contact during feeding by Cuddling and swaddling Clemans-Cope et al. (2020)

4
M.P. Castañeda Sandoval et al.
(Hudak et al., 2012).
As part of non-pharmacological nursing care for newborn infants
with NAS, meeting their nutritional needs for healthy body function and
good health status is important (C. M. Frazier et al., 2021). Both the
mother and child can benefit from lactation and is therefore recom­
mended unless the risks outweigh the benefits (A. P. Holmes et al.,
2017). On-demand breastfeeding provides high-calorie nourishment
and fosters optimal physical development, growth, and immune pro­
tection for newborns. Moreover, it plays a role in minimizing the need
for pharmacological treatment and reducing hospitalization rates
among newborns (L. M. Frazier et al., 2020).
Stress caused by loud noises and bright lighting, external factors that
have the greatest impact on newborns, causes changes in sleep cycles,
delays growth, and altered vital signs. Therefore, nursing care is con­
cerned with maintaining a quiet, comfortable environment with mini­
mal sensory stimulation (Bio et al., 2011; MacMullen and Samson,
2018). Some interventions used include open cradles, correct posi­
tioning, swaddling to promote temperature regulation and extending
sleep duration time (Clemans-Cope et al., 2020; Mangat et al., 2019).
To encourage social integration, the practice of rooming-in is rec­
ommended to keep newborns calm. Allowing newborns to familiarize
themselves with their mother’s voice and heartbeat can be immensely
reassuring for them (Brown et al., 2015; Whalen et al., 2019). Other
important nursing care practices include skin-to-skin contact and
maternal-infant bonding. Promoting and facilitating a newborn to bond
by hugging, cuddling, and holding them close to the chest is essential so
that they can perceive smells, and hear heartbeats or natural sounds
from the parents or nursing staff (Hignell et al., 2020; Hudak et al., 2012;
Maguire et al., 2018; Minear and Wachman, 2019; Shannon et al., 2021;
Shannon et al., 2021). Facilitating rooming-in and encourage
skin-to-skin contact have proven to be effective in soothing infants with
NAS, as well as improving their heart rate, breathing patterns and
appetite (A. V. Holmes et al., 2016).
Alternating therapeutic modalities such as acupuncture, laser
acupuncture, and vibrotactile stimulation can offer valuable benefits as
adjunct treatments for newborns with NAS. These interventions have
shown promising results in reducing anxiety, promoting a sense of
calmness and rest, and enhancing feeding outcomes. Furthermore,
auricular acupressure protocols have been implemented to improve the
care provided to newborns with NOWS during hospitalization (Filippelli
et al., 2012; Jackson et al., 2020; Raith et al., 2015) and a significant
reduction in the duration of morphine therapy was observed in new­
borns with NAS after laser acupuncture treatment, further highlighting
the potential of these approaches (Raith et al., 2015).
Employing swaddling techniques and providing comfort to newborn
in a supine position, accompanied by gentle rocking, and the use of
pacifiers, significatively reduce jitteriness and the incidence of tachyp­
nea and tachycardia. Additionally, these measures help enhance
breathing patterns (Clemans-Cope et al., 2020; Jackson et al., 2020;
MacMullen and Samson, 2018).
C positioning, swaddling, and vertical rocking all help to soothe and
relax fretful newborns with NAS (Jackson et al., 2020; Maguire et al.,
2018). However, Maichuk et al. concluded that a prone position is more
advantageous for managing fretfulness and serves as a significant
endogenous source of neonatal pacification (Maichuk et al., 1999).
Among this study’s limitations are the inclusion of articles published
only in English and Spanish, as well as the specific databases utilized, as
described in the methods section. Regarding the implications for nursing
practice and future research, this study’s results show relevant in­
terventions to design nursing care plans based on scientific evidence.
5. Conclusion
Non-pharmacological nursing care for newborns with NAS addresses
feeding methods, including lactation and nutritional support; environ­
mental controls; social integration; and the use of alternative therapies
5
Journal of Neonatal Nursing xxx (xxxx) xxx
and soothing techniques.
The nursing care identified here for the management of NAS in­
tegrates new techniques and procedures that require nurses to adopt a
holistic, evidence-based approach to care that improves clinical practice
and the health status of mothers and newborns with NAS.
References
Adrian, A., 2019. Factors influencing healthcare providers’ behaviors in the care of
infants with neonatal abstinence syndrome (NAS): an integrative review. J. Neonatal
Nurs. 25 (6), 304–310. https://doi.org/10.1016/j.jnn.2019.07.006.
Archivo Nacional de Datos, 2020. Colombia - Encuesta Nacional de Consumo de
Sustancias Psicoactivas en Población General - ENCSPA- 2019. Departamento
Administrativo Nacional de Estadística 1, 1–3. https://www.dane.gov.co/files/in
vestigaciones/boletines/encspa/bt-encspa-2019.pdf.
Arksey, H., O’Malley, L., 2005. Scoping studies: towards a methodological framework.
Int. J. Soc. Res. Methodol.: Theor. Pract. 8 (1), 19–32. https://doi.org/10.1080/
1364557032000119616.
Bio, L.L., Siu, A., Poon, C.Y., 2011. Update on the pharmacologic management of
neonatal abstinence syndrome. J. Perinatol. 31 (11), 692–701. https://doi.org/
10.1038/jp.2011.116.
Brown, M.S., Hayes, M.J., Thornton, L.M., 2015. Methadone versus morphine for
treatment of neonatal abstinence syndrome: a prospective randomized clinical trial.
J. Perinatol. 35 (4), 278–283. https://doi.org/10.1038/jp.2014.194.
Clemans-Cope, L., Holla, N., Lee, H.C., Cong, A.S., Castro, R., Chyi, L., Huang, A.,
Taylor, K.J., Kenney, G.M., 2020. Neonatal abstinence syndrome management in
California birth hospitals: results of a statewide survey. J. Perinatol. 40, 463–472.
https://doi.org/10.1038/s41372-019-0568-6.
Comisión Interamericana para el Control de Drogas (CICAD), 2019. Informe sobre el
consumo de drogas en las Américas 2019. http://www.cicad.oas.org/oid/Informe%
20sobre%20el%20consumo%20de%20drogas%20en%20las%20Am%C3%A9ricas%
202019.pdf.
Congreso de la República de Colombia, 2016. Ley 1566 del 2012 Atención integral a
personas que consumen sustancias psicoactivas, vol. 2012. https://www.defensoria.
gov.co/public/Normograma2013_html/Normas/Ley_1566_2012.pdf.
Congreso de la República de Colombia, 2021. Ley 1385 del 2010 Prevenir del síndrome
de alcoholismo fetal. Pub. L. No, p. 3. Ley 1385/2010. https://www.icbf.gov.co/c
argues/avance/docs/ley_1385_2010.htm.
Filippelli, A.C., White, L.F., Spellman, L.W., Broderick, M., Highfield, E.S., Sommers, E.,
Gardiner, P., 2012. Non-insertive acupuncture and neonatal abstinence syndrome: a
case series from an inner-city safety net hospital. Glob. Adv. Health Med. 1 (4),
48–52. https://doi.org/10.7453/gahmj.2012.1.4.007.
Frazier, C.M., Dharod, J., Labban, J., Raynor, A.N., Villasenor, M., Hernandez, M.,
Ramos-Castillo, I., 2021. Breastfeeding: how is it related to food insecurity and other
factors among low-income mothers? Health Care Women Int. 1 https://doi.org/
10.1080/07399332.2021.1929992/FORMAT/EPUB. –12.
Frazier, L.M., Bobby, L.E., Gawronski, K.M., 2020. Emerging therapies for the treatment
of neonatal abstinence syndrome. J. Matern. Fetal Neonatal Med. 35 (5), 987–995.
https://doi.org/10.1080/14767058.2020.1733522.
Hignell, A., Carlyle, K., Bishop, C., Murphy, M., Valenzano, T., Turner, S., Sgro, M., 2020.
The Infant Cuddler Study: evaluating the effectiveness of volunteer cuddling in
infants with neonatal abstinence syndrome. Paediatr. Child Health 25 (7), 414–418.
https://doi.org/10.1093/pch/pxz127.
Holmes, A.P., Schmidlin, H.N., Kurzum, E.N., 2017. Breastfeeding considerations for
mothers of infants with neonatal abstinence syndrome. Pharmacotherapy 37 (7),
861–869. https://doi.org/10.1002/PHAR.1944.
Holmes, A.V., Atwood, E.C., Whalen, B., Beliveau, J., Jarvis, J.D., Matulis, J.C.,
Ralston, S.L., 2016. Rooming-In to treat neonatal abstinence syndrome: improved
family-centered care at lower cost. Pediatrics 137 (6). https://doi.org/10.1542/
peds.2015-2929.
Holmes, M., Wright, M.E., Dowling, D., Thibeau, S., 2019. Survey of neonatal intensive
care unit nurses’ use of a motion/sound infant seat. Adv. Neonatal Care 19 (2),
151–159. https://doi.org/10.1097/ANC.0000000000000579.
Hudak, M.L., Tan, R.C., Frattarelli, D.A.C., Galinkin, J.L., Green, T.P., Neville, K.A.,
Paul, I.M., Van Den Anker, J.N., Hegenbarth, M., Knight, M., Shaddy, R.E.,
Snodgrass, W.R., Alexander, J.J., Chescheir, N.C., Cragan, J.D., Rieder, M.J.,
Robb, A., Sachs, H.C., Zajicek, A., et al., 2012. Neonatal drug withdrawal. Pediatrics
129 (2), 540–560. https://doi.org/10.1542/peds.2011-3212.
Jackson, H.J., Lopez, C., Miller, S., Englehardt, B., 2020. Feasibility of auricular
acupressure as an adjunct treatment for neonatal opioid withdrawal syndrome
(NOWS). Subst. Abuse 42 (3), 348–357. https://doi.org/10.1080/
08897077.2020.1784360.
Kocherlakota, P., 2014. Neonatal abstinence syndrome. Pediatrics 134 (2), e547–e561.
https://doi.org/10.1542/PEDS.2013-3524.
MacMullen, N.J., Samson, L.F., 2018. Neonatal abstinence syndrome: an uncontrollable
epidemic. Crit. Care Nurs. Clin. 30, 585–596. https://doi.org/10.1016/j.
cnc.2018.07.011.
Maguire, D.J., Shaffer-Hudkins, E., Armstrong, K., Clark, L., 2018. Feeding infants with
neonatal abstinence syndrome: finding the sweet spot. Neonatal Network 37 (1),
11–18. https://doi.org/10.1891/0730-0832.37.1.11.
Maichuk, G.T., Zahorodny, W., Marshall, R., 1999. Use of positioning to reduce the
severity of neonatal narcotic withdrawal syndrome. J. Perinatol. 19 (7), 510–513.
https://doi.org/10.1038/sj.jp.7200260.
M.P. Castañeda Sandoval et al.
Mangat, A.K., Schmölzer, G.M., Kraft, W.K., 2019. Pharmacological and non-
pharmacological treatments for the neonatal abstinence syndrome (NAS). National
Library of Medicine 24 (2), 141. https://doi.org/10.1016/J.SINY.2019.01.009.
McLemore, G.L., Lewis, T., Jones, C.H., Gauda, E.B., 2013. Novel pharmacotherapeutic
strategies for treatment of opioid-induced neonatal abstinence syndrome. Semin.
Fetal Neonatal Med. 18 (1), 35–41. https://doi.org/10.1016/j.siny.2012.09.002.
Mellado, J.E., Pastor Rodríguez, J., Del Cerro Ortuño, F., De Ardanaz Jorreto, S., López
Ibáñez, M., 2008. Manejo y control del síndrome de abstinencia. Enfermería Glob. 7
(1), 11–21. https://doi.org/10.6018/eglobal.7.1.971.
Menéndez García, X., Álvarez García, N., García Rodríguez, J., 2018. Sustancias adictivas
y embarazo: cuidados de enfermería a la mujer embarazada y al recién nacido para
minimizar sus efectos. Enfermería Comunitaria 6 (2), 34–49. https://dialnet.unirioja
.es/servlet/articulo?codigo=6490892.
Minear, S., Wachman, E.M., 2019. Management of newborns with prenatal opioid
exposure: one institution’s journey. Clin. Therapeut. 41 (9), 1663–1668. https://doi.
org/10.1016/j.clinthera.2019.07.001.
Ministerio de Salud y Protección Social, 2019. Política Integral para la Prevención y
Atención del Consumo de Sustancias Psicoactivas, vol. 44. La Salud Es de Todos
Minsalud.
Ministerio de Salud y Protección Social, 2022. Plan Decenal De Salud Publica PDSP
2022-2031, pp. 1–691. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigi
tal/RIDE/VS/ED/PSP/documento-plan-decenal-salud-publica-2022-2031.pdf.
Pomar, E.G., Finnegan, L.P., Devlin, L., Bada, H., Concina, V.A., Ibonia, K.T., Westgate, P.
M., 2017. Simplification of the finnegan neonatal abstinence scoring system:
Journal of Neonatal Nursing xxx (xxxx) xxx
retrospective study of two institutions in the USA. BMJ Open 7 (9), 1–7. https://doi.
org/10.1136/bmjopen-2017-016176.
Raith, W., Schmölzer, G.M., Resch, B., Reiterer, F., Avian, A., Koestenberger, M.,
Urlesberger, B., 2015. Laser acupuncture for neonatal abstinence syndrome: a
randomized controlled trial. Pediatrics 136 (5), 876–884. https://doi.org/10.1542/
peds.2015-0676.
Shannon, J., Blythe, S., Peters, K., 2021a. The complexities associated with caring for
hospitalised infants with neonatal abstinence syndrome: the perspectives of nurses
and midwives. Children 8 (2), 152. https://doi.org/10.3390/children8020152.
Shannon, J., Peters, K., Blythe, S., 2021b. The challenges to promoting attachment for
hospitalised infants with nas. Children 8 (2), 1–13. https://doi.org/10.3390/
children8020167.
Sierra, A.M., Lopez-Vilchez, M.A., Panades, A.P., 2008. Abuso de tóxicos y gestación,
vols. 145–158. Asociación Española de Pediatría. https://www.aeped.es/sites/defa
ult/files/documentos/17_1.pdf.
United Nations Office On Drugs and Crime (UNODC), 2022. World drug Report. United
Nations publication 18 (Issue 1.9). https://doi.org/10.1080/00909887909365203.
Whalen, B.L., Holmes, A.V., Blythe, S., 2019. Models of care for neonatal abstinence
syndrome: what works? Semin. Fetal Neonatal Med. 24 (2), 121–132. https://doi.
org/10.1016/j.siny.2019.01.004.
Zapata Diaz, J.P., Rendón Fonnegra, J., Berrouet, M.C., 2017. Síndrome de abstinencia
neonatal. Pediatria 50 (2), 52–57. https://doi.org/10.14295/pediatr.v50i2.60.