Neonatal abstinence syndrome is defined as a condition where neonates have experienced in utero exposure to opioids or other substances used by the mother causing withdrawal symptoms 24-72 hours post birth (Edwards & Brown, 2016). This chapter will consider the effects of a wide range of drugs and substances that have been prescribed or abused during pregnancy. Clinical manifestation of neonatal abstinence syndrome (NAS) will be outlined including nursing care and management. Key aspects of nursing management and education for mothers will be outlined during antenatal care, to identify and decrease the potential risks of NAS in the neonate. The drugs and substances that are abused or prescribed during pregnancy vary and are dependent on current trends, geographical locations and availability. This chapter will provide an overview of the common scoring tools available for assessment of NAS and the use of these tools within the neonatal unit.