Pharmacy and Wellness Review


Neonatal abstinence syndrome (NAS) is a concern for infants born to mothers receiving treatment with a selective serotonin reuptake inhibitor (SSRI) throughout the pregnancy. The risk of NAS associated with SSRI use during pregnancy varies with the specific SSRI that is used by the patient during pregnancy. Common symptoms of NAS include premature delivery, gastrointestinal disturbances, irritability, low birth weight, short length and lack of response to various stimuli. Neonates that present with these symptoms can be scored using either the Finnegan or Lipsitz scoring tools. Neonates experiencing NAS can be calmed or treated using nonpharmacologic methods such as swaddling, rocking, exposure to calming scents, soft light and soothing music. Drugs such as morphine or phenobarbital may be used as needed. Monitoring children born with NAS is important as it is possible that these children may express long-term behavioral, social and intellectual developmental problems. While there are many health care professionals involved in the care of NAS, pharmacists can play a large role in both preventing and treating NAS. Importantly, pharmacists can work with pregnant mothers to help prevent NAS by recommending SSRIs that have less risk of causing high serotonin levels in neonates. Pharmacists can also help by offering nonpharmacologic treatment options, when appropriate, or by developing protocols for the treatment of NAS.



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