From the Guidelines
NAS scoring is not beneficial for preterm infants post-operatively because it may not accurately assess withdrawal symptoms in this population due to their unique physiological responses and immature neurological development. The clinical evaluation of the severity of abstinence may be more difficult in preterm infants, because scoring tools to describe withdrawal were largely developed in term or late preterm infants 1. Preterm infants have been described as being at lower risk of drug withdrawal with less severe and/or prolonged courses, and lower gestational age correlated with a lower risk of neonatal withdrawal 1.
Limitations of NAS Scoring in Preterm Infants
- The signs evaluated in NAS scoring, such as high-pitched crying, increased muscle tone, and exaggerated reflexes, overlap with normal preterm infant behaviors or may be affected by their immature neurological development 1.
- Post-operative pain management in preterm infants requires specialized assessment tools that account for their unique physiology and limited ability to express pain.
- Tools specifically designed for preterm infants, such as the Premature Infant Pain Profile (PIPP), CRIES (Crying, Requires oxygen, Increased vital signs, Expression, Sleeplessness), or N-PASS (Neonatal Pain, Agitation and Sedation Scale), should be used to assess post-operative pain and potential withdrawal symptoms 1.
Alternative Assessment Tools
- The Premature Infant Pain Profile (PIPP) is a validated tool for assessing pain in preterm infants, taking into account their gestational age and physiological responses 1.
- CRIES and N-PASS are also suitable for assessing post-operative pain and potential withdrawal symptoms in preterm infants, as they consider gestational age-appropriate responses and provide more accurate assessments for guiding pain management and medication weaning in this vulnerable population 1.
From the Research
NAS Scoring Limitations in Preterm Infants
- The Finnegan scoring system, commonly used to assess Neonatal Abstinence Syndrome (NAS), has limitations in evaluating preterm infants 2.
- Preterm infants may exhibit different NAS symptoms compared to full-term infants, making it challenging to accurately assess their condition using existing scoring tools 2, 3.
- Studies have shown that preterm infants tend to score lower on traditional NAS scoring systems, which may lead to underestimation of their symptoms and inadequate treatment 2, 3.
Need for Modified NAS Scoring Tools
- There is a need for modified NAS scoring tools that can accurately assess preterm infants, taking into account their unique symptoms and developmental stage 2, 3.
- Emerging therapies, such as buprenorphine and clonidine, may offer alternative treatment options for NAS, but their effectiveness in preterm infants requires further study 4.
- Newer NAS assessment modalities, such as the eat, sleep, console (ESC) approach, may also provide a more accurate evaluation of preterm infants, but require validation in this population 3.
Challenges in NAS Management
- The lack of standardized care plans and validated assessment tools for NAS in preterm infants poses significant challenges in their management 5, 2.
- Healthcare providers must be aware of the differences in NAS manifestations between preterm and term infants to provide optimal care 2.
- Further research is needed to develop effective and standardized approaches to NAS management in preterm infants, including the development of modified scoring tools and evaluation of emerging therapies 5, 2, 4.