An atypical withdrawal syndrome in neonates prenatally exposed to gabapentin and opioids

Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome that primarily occurs after in utero exposure to opioids. In the US, it is estimated that 1 infant is born every 25 minutes with NAS, representing $1.5 billion in additional hospital charges. NAS is increasing in frequency and can represent as many as 50% of admissions to some neonatal intensive care units. Gabapentin was approved in the US in 1993 for the treatment of partial seizures and has been prescribed increasingly for a number of other conditions. Recently, nonprescription gabapentin use has been reported among opioid abusers to potentiate the opioid high. In this retrospective case series, we describe infants born to mothers at our institution who have used both opioids and gabapentin, describe a unique withdrawal syndrome, and report a successful treatment strategy