Background and aims In light of the current epidemic in the abuse of opioids, a major increase in neonates with neonatal abstinence syndrome (NAS) is likely. Incorporation of breastfeeding as a first pillar of treatment of NAS seems appropriate. We aimed to quantify the impact of breastfeeding on the incidence and severity of NAS.

Methods Pooling of published NAS cohorts, with specific emphasis on the impact of breastfeeding on the incidence (yes/no opioid administration) and duration (duration opioids, duration hospitalisation) of NAS.

Results Three studies [1–3] were retrieved and resulted in a pooled dataset of 400 neonates (218 breastfed, 54.5%). There is a significant reduction in NAS (54 vs 77%, number needed to treat 5–6). The same trends are observed when the duration of opioid treatment (difference -18 to -23 days) or the length of hospital stay (difference -4 to -10 days) are considered.

Conclusions Breastfeeding is associated with a clinical significant reduction on both the incidence and the duration of NAS in opioid exposure newborns. Incorporation of breastfeeding as a first pillar of treatment for relieving the NAS symptoms seems to be a very natural, and effective way of addressing this.

References Abdel-Lalif ME et al. Pediatrics 2006

Wachman EM et al. JAMA 2013

Welle-Strand GK et al. Acta Paediatr 2013