Which pharmacologic management option is commonly used for neonatal abstinence syndrome (NAS)?

• A. Ibuprofen and acetaminophen.
• B. Morphine or Methadone with supportive care and gradual weaning.
• C. Fentanyl with supportive care.
• D. Codeine.

Answer: (B)

Opioid replacement therapy with morphine or methadone, plus supportive care and a gradual taper, is the standard approach for neonatal abstinence syndrome. When a newborn was exposed to opioids before birth, easing withdrawal with a carefully dosed opioid provides controlled relief of autonomic and behavioral symptoms and allows a smooth, slow decrease of dependence. The drug choice matters because morphine and methadone have well-established dosing ranges, predictable effects, and proven taper schedules that align with how a baby metabolizes opioids, helping to shorten the hospital stay and reduce complications. Supportive care—gentle handling, swaddling, minimizing stimulation, frequent small feeds, and careful monitoring of hydration and respiration—complements pharmacologic treatment and supports recovery.

Other options don’t treat the withdrawal process as effectively. Ibuprofen and acetaminophen can help with pain but don’t address the underlying opioid dependence driving NAS. Codeine is avoided due to unreliable metabolism and potential safety risks in neonates. Fentanyl can be used in some settings, but it is not the most commonly chosen first-line agent for NAS because of concerns around dosing practicality, safety, and long-term outcomes.