TABLE 2

Oral Morphine Weaning Protocol and Enteral Morphine Protocol for NAS

Wean: Once stabilized on a dose for 72–96 h, use this dose as the starting point of the wean (please note this dose on infant’s card). Begin weaning the dose by 10% (of the original dose when the first wean was started) every 24–48 h. Drug may be discontinued when a single dose is <0.02 mg/kg/dose. Please see below for example.
 Ad lib infants: Given the shorter duration of action of enteral morphine, it is best suited to be dosed on a q3hr schedule. Infants should be allowed to ad lib feed volumes but kept on a q3hr schedule.
 Backslide: If infant’s NAS scores become consistently elevated (example, 2 consecutive ≥8) during the weaning process, ensure that nonpharmacological measures are optimized (ie, swaddling, holding, decreased stimuli, etc) before going back to pervious dose at which patient was stable. If infant’s scores continue to be elevated (even after physical examination to ensure nothing else is wrong/bothering the infant), either weight adjust medication and/or continue to back up in a stepwise fashion until patient’s scores are <8. Once stabilized on a new dose for minimum 48 h resume 10% wean but consider weaning at longer intervals.
Discharge: Observe in-house × 48–72 h off of medication before discharge.