Neonatal Abstinence Syndrome Guidelines

This policy covers diagnosis, monitoring, and treatment of Neonatal Abstinence Syndrome/NOWS and other neonatal withdrawal or adaptation syndromes from in utero exposures (opioids—prescribed or illicit—benzodiazepines/barbiturates/alcohol, SSRIs/SNRIs, and other substances), including use of modified Finnegan scoring, the Eat‑Sleep‑Console (ESC) approach, pharmacologic therapy (typically morphine), home‑based withdrawal, and continuation of maternal MOUD (buprenorphine/methadone) through delivery. Major limitations/requirements include adherence to ESC or FNAST-based authorization rules for nursery level of care, initiation of pharmacologic therapy only after failure of intensive nonpharmacologic measures, strict clinical stability and neurobehavioral recovery and Finnegan score thresholds for home discharge or home-based therapy, and restrictions on breastfeeding and toxicology testing consistent with clinical and state/legal requirements.

"Neonatal Abstinence Syndrome (NAS) in infants with intrauterine opioid exposure (prescribed or illicit)."