In this section : Neonatal
Infant hip clinic referral form
Vaccination referral form
Assessment and management of babies who are accidentally dropped in hospital
DGRI NNU Guideline for Management of Cord Blood Gas Results
NNU Admission Criteria
Antenatal Drugs for NAS Monitoring
Neonatal Guidelines
Antenatal Drugs for NAS Monitoring
Last updated 27th August 2024
*This guidance should be used as an aid in risk assessment and decision making for relevant cases. For the full guidance on the assessment and management of babies who fit the criteria for monitoring of Neonatal Abstinence Syndrome, please see the West of Scotland Guideline titled “Neonatal Abstinence Syndrome (NAS)” https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-guidelines/neonatology/neonatal-abstinence-syndrome-nas/
Category A | Category B | Category C | Category D |
Plan goes in Badger for 5 days postnatal monitoring as per West of Scotland guideline. Any other specific actions required should also be noted: Opioids overuse, regular use throughout pregnancy and/or regular use in the weeks prior to delivery (eg. Codeine, Dihydrocodeine, Cocodamol, Tramadol, Methadone, Buprenorphine, Morphine, Diamorphine, Fentanyl) Benzodiazepines (eg. Diazepam, Lorazepam, Temazepam, Nitrazepam, Chlordiazepoxide, Clobazam, Clonazepam) Antipsychotics (eg.Chlorpromazine, Haloperidol, Amisulpride, Aripiprazole, Clozapine, Olanzapine, Quetiapine, Risperidone) Hypnotics (eg. Zolpidem, Zopiclone) Recreational drugs (eg. Cocaine, Amphetamines, Heroin) Polysubstance use (including 2 or more category B drugs/medications/substances) | Plan goes in Badger for no specific monitoring postnatally but information to be given to the family verbally and with the appropriate leaflet. No further action required unless baby develops symptoms: SSRIs (eg. Fluoxetine, Sertraline, Citalopram, Paroxetine, Dapoxetine, Escitalopram, Fluvoxamine) SNRIs (eg. Duloxetine, Venlafaxine) Tetracyclics/NASSAs (eg. Mirtazepine) Tricyclics (eg. Clomipramine, Lofepramine, Amitryptyline, Imipramine, Notriptyline) Isolated cannabis or alcohol misuse *Advice given at time of discharge should emphasise the importance of return to hospital for assessment if there are any concerns. Do not issue scoring charts to be used at home. *Links to recommended websites which have useful leaflets for parents and carers include: NHS Inform https://www.choiceandmedication.org/nhs24/printable-leaflets/drugs-in-pregnancy/ BUMPS (Best Use of Medicines in Pregnancy) https://www.medicinesinpregnancy.org/ | Antenatal drug/medication/substance with no known risk of withdrawal: ADHD medication (eg. Methylphenidate, Atomoxatine) Anticonvulsants (eg. Carbamazepine, Lamotrigine, Sodium Valproate, Pregabalin) Antihistamines (eg. Loratidine, Cetirizine, Diphenydramine, Promethazine) Antihypertensives (eg. Labetolol, Atenolol, Propanolol, Amlodipine, Nifedipine, Enalapril, Lisinopril, Candesartan, Losartan) Anticholinergics (eg. Procyclidine) * Please note that, while this guideline refers specifically to antenatal drugs/medications/ substances which require postnatal monitoring for NAS, some will require postnatal specialist review or monitoring for other reasons. For example, babies born to mothers prescribed Beta-Blockers such as Labetolol will require monitoring of blood sugars as per that specific guideline. | Antenatal drug/medication/ substance of concern not covered by our list. Neonatal referral to be submitted for individual risk assessment and Paediatric plan. |
References:
- MCN for Neonatology West of Scotland Neonatal Guideline February 2019, “Neonatal Abstinence Syndrome (NAS)” https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-guidelines/neonatology/neonatal-abstinence-syndrome-nas/
- NHS Inform https://www.choiceandmedication.org/nhs24/printable-leaflets/drugs-in-pregnancy/
- BUMPS (Best Use of Medicines in Pregnancy) https://www.medicinesinpregnancy.org/
- British National Formulary (BNF) 2020
Other specialties consulted:
Wendy Ackroyd, Lead Pharmacist, Mental Health Directorate, NHS Dumfries & Galloway