Discharge Planning for NAS Babies

The continuing opioid crisis in Virginia has impacted a wide variety of populations, including a growing number of infants born with neonatal abstinence syndrome (NAS). These babies present particularly complex symptoms and require additional treatment plans when they are ready to discharge home.

It’s important to work closely with the baby’s mother in a supportive, non-judgmental manner to ensure that she feels encouraged, not shamed, emphasizes Dr. Alta DeRoo, OB/GYN and addiction medication specialist, UVA Health System.

After the baby has been in the hospital for a minimum of four days and has completed any needed NAS medical treatment, a specific discharge checklist is used to determine whether the infant can go home, explains Dr. DeRoo.

The checklist includes the following protocols for determining infant discharge eligibility:

  • Infant weaned off medication and observed for at least 24 hours after weaning
  • Infant is successfully feeding
  • Caregivers received education about recognition of infant signs of NAS and have necessary contact information of responsive medical personnel to call with concerns
  • Caregivers have received education about how to soothe the baby (dim lights, softly playing white noise, skin-to-skin contact, pacifier, swaddling) and ways to recognize and respond to infant’s inability to regulate their responses and emotions.
  • Caregivers are responding to infant’s needs in a safe, responsive way
  • Caregivers have been educated on the Safe to Sleep Campaign and the infant has his/her own place to sleep to reduce the risk of Sudden Unexplained Infant Death Syndrome (SIDS),
  • Caregivers have received education about follow-up plans that include home visits and early pediatric follow-up appointments (within five days of discharge), along with safety planning.

If all these items are checked off, the infant is ready to be considered for discharge.

Healthcare providers should remind parents that a healthy home environment is critical to healthy development of their baby, from infancy to adolescence. Routine pediatric health maintenance is critical, particularly in the first two years. Healthcare professionals have a unique opportunity to recognize and assess a child’s risk, to intervene to protect the child and to help the child’s parents or caregivers improve their parenting skills and the home environment.

In particular, the mother’s ongoing engagement in treatment and recovery support for opioid use disorder is essential for a healthy home environment. “Understand that a mom in your care suffering from a SUD or OUD doesn’t want to be using drugs. She wants to live a drug-free life and raise her baby in a stable, drug free environment. Respect this common goal and do whatever you can in your power to assist her,” says Dr. DeRoo.