| dc.description.abstract | Background: Neonatal Abstinence Syndrome (NAS) is a complex disorder, observed in infants
experiencing symptoms of withdrawal, as a result of in utero exposure to the maternal use of
opioids. Breastfeeding has been recognized as the optimal source of nutrition for infants. While
the advantages associated with breastfeeding are undisputed, the promotion of breastfeeding for
infants diagnosed with neonatal abstinence syndrome is inconsistent. There is evidence to
suggest that breastfeeding infants who have been exposed to opioids in utero may improve NAS
outcomes.
Aim: A systematic review was conducted to assess and critically appraise the existing literature
regarding the effect of infant feeding method among infants with Neonatal Abstinence Syndrome
(NAS) on neonatal outcomes.
Method: A systematic search of the literature of feeding methods among infants with NAS was
conducted using the electronic databases Pubmed, CINAHL, Nursing and Allied Health,
PyschINFO, Evidence Based Medicine, Web of Science, and Medline (EMBASE). Studies were
eligible for inclusion in the review if they fulfilled the following criteria: (1) reported original
data on outcomes related to infant feeding and NAS, (2) the study method included any type of
quantitative design that included an inpatient comparison group of breastfed and formula fed
infants with NAS, and (3) the articles were published in English in a peer reviewed journal. All
articles selected for inclusion were assessed for methodological quality by first and secondary
author using the JBI standardized critical appraisal checklist for cohort/case control studies and
the JBI standardized critical appraisal checklist for randomized controlled studies. The principal
author extracted the data from the full text studies and entered it into a data extraction template
developed for the systematic review. The secondary authors independently reviewed and compared the extracted data. The data was synthesized narratively due to the diverse study
samples and outcomes that were evaluated.
Results: The search identified 491 studies, of which 17 provided information related to NAS and
infant feeding method. Eight studies met the inclusion and exclusion criteria after further
examination of the full-text studies. The majority of studies found that breastfeeding was
associated with a reduced need for pharmacologic treatment and a decrease in the duration of
pharmacotherapy when compared to formula-fed or combination-fed infants. Breastfeeding,
when compared to formula-feeding, was also consistently associated with a shorter
hospitalization and a reduced severity of NAS, including lower Finnegan scores. Studies also
identified a later time to withdrawal and a delayed onset of NAS associated with breastfed
infants when compared to formula-fed infants.
Conclusions and Relevance: The studies consistently identified a trend towards improved NAS
outcomes for infants who were breastfed when compared to formula or combination-fed. These
findings provide evidence for breastfeeding as an effective non-pharmacologic treatment for
NAS. Breastfeeding among stabilized mothers on Opioid Maintenance Therapy (OMT) should
be recommended as a non-pharmacologic approach to improving NAS outcomes. | en_US |
