The American Academy of Pediatrics Committee on Drugs recommends which of the following regimens as optimal treatment for neonatal abstinence syndrome (NAS)?

• A. Methadone and Buprenorphine
• B. Morphine and Clonidine
• C. Recommendation for optimal initial drug or regimen cannot be made
• D. Morphine and Buprenorphine

Answer: (C)

The main idea is that there isn’t a single universally optimal initial drug or regimen for neonatal abstinence syndrome. The AAP Committee on Drugs emphasizes an individualized approach because NAS varies widely in presentation and in the type and extent of exposure, and the evidence comparing different pharmacologic regimens is not strong enough to declare one option as universally best. In practice, clinicians use opioid therapy (commonly morphine or methadone) and tailor the dosing to the infant’s symptoms, often guided by a withdrawal scoring tool, with adjustments based on response. Nonpharmacologic care and family involvement are also important, and adjuncts like clonidine may be used selectively in certain cases. Because outcomes differ across infants and study results are not consistently conclusive, no single initial regimen can be labeled the optimal choice.