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NAS – morphine — RACP Paediatrics MCQ

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ModerateNeonatalNAS – morphineRACP Paediatrics

A term neonate born to a mother on methadone maintenance therapy develops irritability, high-pitched cry, tremors, poor feeding, and loose stools at 48 hours of age. Finnegan scoring shows scores consistently >8. Non-pharmacological measures have been optimised. What is the most appropriate first-line pharmacological treatment?

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Correct answer: D — Morphine

For neonatal abstinence syndrome (NAS) requiring pharmacological treatment (Finnegan scores consistently >8 despite non-pharmacological measures), oral morphine is the standard first-line treatment in Australia. It is titrated based on NAS scores and weaned gradually. Non-pharmacological measures (swaddling, demand feeding, low-stimulation environment, skin-to-skin, breastfeeding if appropriate) should be maximised first.

Reference: RCH Melbourne – 2023 – Neonatal Abstinence Syndrome CPG; RACP Paediatric Curriculum – Neonatology