Evaluating Nutritional Selection and Outcomes in Neonatal Abstinence Syndrome: A Retrospective Review

Gallegos, Juan A. DO
Serke, Laura RD
Feygin, Yana MS
Jawad, Kahir PhD
Robinson, Tonya MD
Telang, Sucheta MBBS

¹Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky,
²Department of Pediatrics, Dell Medical School, University of Texas, Austin, Texas,
³Nutrition Therapy Department, University of Louisville Hospital, Louisville, Kentucky,
⁴Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky,

Address for correspondence

Sucheta Telang, MBBS, Departments of Pediatrics and Medicine, University of Louisville School of Medicine, 505 S. Hancock St., Louisville, KY 40202 e-mail; [email protected]

Conflict of Interest

None declared.

American Journal of Perinatology 42(6):p 742-750, April 2025. | DOI: 10.1055/a-2418-9886

Abstract

Objective

The rising incidence of neonatal abstinence syndrome (NAS) has amplified the importance of nonpharmacological interventions in its management, which include the selection of feedings. With the goal of obtaining an accurate assessment of the effects of current feeding practices in NAS infants in our neonatal intensive care unit, we conducted a retrospective review of NAS infants at our hospital over a 3-year period to determine their nutritional selections and evaluate their length of stay (LOS), length of treatment (LOT), and growth outcomes.

Study Design

Retrospective chart review of term infants (≥37 weeks of gestation) with NAS. Maternal and infant demographics and characteristics were recorded. Infants were grouped based on majority (>50% of total feeding) nutritional selections and LOS, LOT, and growth parameters were evaluated. Linear regression was used to compare group outcomes. Significance was set at a p -value <0.05.

Results

A total of 70 infants were included and grouped based on majority feeds into maternal breast milk (MBM), standard term formula (STF), low lactose formula (LLF), and extensively hydrolyzed formula (EHF) groups. Feeding selections were provider-dependent and infants were placed on MBM or STF as an initial selection. In all infants included in our review, LLF was selected as the first choice following MBM or STF for increased gastrointestinal (GI) disturbance-related Finnegan Neonatal Abstinence Scoring scores and changed to EHF if LLF failed to improve the GI-related symptoms. The STF-fed infants had the shortest LOS, and none of these infants required pharmacological treatment. The LOT and LOS were similar in the MBM- and LLF-fed groups. Infants who were EHF fed had the longest LOT and LOS. All feeding groups demonstrated appropriate growth.

Conclusion

Nutritional selections in our NAS infants were modified for the severity of their withdrawal symptoms. All nutritional modifications driven by severity of withdrawal symptoms supported favorable growth outcomes in the infants.

Key Points

Our NAS infants were fed with multiple types of nutrition.
Infants with severe NAS required more elemental feeds.
All formula selections supported favorable growth.