Neonatal abstinence syndrome in countries with no to low medical opioid consumption: a scoping review.

AIM: To describe the current state of evidence on the care of neonates with neonatal abstinence syndrome in countries with low to virtually no medical opioid analgesic consumption.

BACKGROUND: While access to opioids for medical use improves globally, misuse grows as a health concern. One unintended consequence has been an increase in the incidence of neonatal abstinence syndrome. Because most evidence is generated in countries with adequate opioid analgesic consumption, a picture of evidence in lower opioid-consuming countries is not available.

DESIGN: A scoping review methodology was employed and augmented with principles of international development literature review. Electronic database searches (PubMed and CINAHL) located 1106 articles. Google was employed to access an additional 17 non-indexed articles. From the total of 1123 articles located, 27 articles from 15 countries were included.

RESULTS: Minimal evidence was produced in low to virtually no medical opioid-consuming countries. Sources were primarily review articles, descriptive, comparative or case reports. Seventy-one per cent of the articles identified at least one specific clinical practice related to the care of infants with neonatal abstinence syndrome.

CONCLUSIONS: As opioid analgesic use increases globally, a subsequent increase in neonatal abstinence syndrome is likely. It will be beneficial for providers and policymakers to be proactive in considering implications for neonatal and maternal populations and collaborate with providers who have been gaining experience in this area. A number of these countries are heroin-growing regions and already experiencing issues.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY: Policymakers may use these findings to support data collection and reporting, context and resource relevant guideline development, and advocacy for inclusion of the maternal-infant population in global opioid research priority setting. International collaboration for establishing gender and culturally appropriate practices globally is critical.