therapy reported to: o Decrease length of pharmacological therapy (compared to placebo)71,72 o Decrease length of hospital stay73 o Have a shorter duration of outpatient therapy after discharge compared to phenobarbital74 Methadone • Conflicting evidence about duration of pharmacological treatment required compared with morphine75,76 Buprenorphine • Insufficient data to recommend as standard of care for treating NAS38 o Reported to have significant reduction in length of stay and length of treatment compared to morphine and other medications34,38,77 Queensland Clinical Guideline: Perinatal substance use: neonatal Refer to online version, destroy printed copies after use Page 17 of 33 5.1 Morphine hydrochloride schedule Refer to NeoMedQ morphine hydrochloride78 Table 15. Morphine hydrochloride schedule Total daily dose (oral) Equivalent 6 hourly dose (oral) Equivalent 4 hourly dose (oral) • Commence at 0.5 mg/kg/day in 4 divided doses (6 hourly) 0.125 mg/kg 6 hourly — • If signs not controlled on 0.5 mg/kg/day o Increase total daily dose to 0.7 mg/kg/day 0.175 mg/kg 6 hourly 0.12 mg/kg 4 hourly • If signs not controlled on 0.7 mg/kg/day o Increase total daily dose to 0.9 mg/kg/day 0.225 mg/kg 6 hourly 0.15 mg/kg 4 hourly • If signs not controlled on 0.9 mg/kg/day o Increase total daily dose to 1 mg/kg/day 0.25 mg/kg 6 hourly 0.16 mg/kg 4 hourly • If signs not controlled on 1 mg/kg/day o Consider adding phenobarbital — — Clinical surveillance • Assess baby for signs of NAS using a structured assessment tool o FNAS every 4–6 hours after feeds o ESC every 3–4 hours after feeds • Paediatrician/nurse practitioner review o Prior to commencing medication o Daily or more frequently until signs of NAS controlled o On maximum dose and still showing signs of NAS • Monitoring o At initiation of morphine, commence cardio-respiratory and/or continuous oxygen saturation monitoring o If morphine dosage 0.7 mg/kg/day or more, commence cardio-respiratory or oxygen saturation o When dose is less than 0.5 mg/kg/day and if nursed in accordance with SIDS guidelines79, respiratory monitoring can be ceased Titration