Nonpharmacologic Interventions For Neonatal Abstinence Syndrome: A Systematic Review Of The Literature

Abstract

The incidence of Neonatal Abstinence Syndrome (NAS) is increasing due to the current opioid epidemic. The foundation of NAS treatment has been pharmacotherapy but nonpharmacologic interventions are increasingly used to alleviate symptoms, reduce the amount of pharmacotherapy needed, and decrease the hospital length of stay (LOS). A systematic review of the literature was performed to identify nonpharmacologic interventions (NPI) that effectively improve NAS treatment outcomes and to identify gaps in current knowledge about NPI. Eight NPI were used as key words in literature searches: infant massage, parental presence, breastfeeding, Reiki, vibrotactile stimulation, acupuncture, non-nutritive sucking, and auditory stimulation. Results found nine studies that met the inclusion criteria: one study investigating the effect of infant massage, three studies on outcomes of parental presence, two studies on the effects of breastfeeding, one study on outcomes of Reiki, one study on vibrotactile stimulation, and one study on laser acupuncture. No studies assessed non-nutritive sucking or auditory stimulation interventions. NPI found to be effective in reducing NAS symptoms were infant massage (one study), parental presence (one study), and breastfeeding (one study). Decreased LOS was associated with parental presence (three studies), breast feeding (one study), and laser acupuncture (one study). Laser acupuncture also reduced the length of time the infant required medication (one study). Parental presence and breastfeeding each had one study where decreased amounts of medication were needed. Reiki and vibrotactile stimulation were not found to be effective interventions. A gap identified is the scarcity of research on the effectiveness of NPI.