Making Special Provisions for Opioid-Exposed Newborns Starts during Pregnancy

Caring for a newborn with neonatal abstinence syndrome (NAS) requires particularly close attention, starting in utero and continuing at the hospital and after discharge.

What exactly is a NAS infant? Babies can experience withdrawal due to the mother taking prescribed medications or illicit drugs. Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics (Stanford University, 2020).

The current opioid crisis has seen a dramatic increase in the number of NAS babies at Virginia hospitals. Ideally the sooner a pregnant woman is diagnosed with Opioid Use Disorder, the better, so that an appropriate treatment plan can be developed.

According to Dr.  Alta DeRoo, OB/GYN and neonatal addiction medication specialist in the UVA Health System, a treatment agreement document typically includes:

  • Risks and benefits of treatment vs no treatment;
  • Schedules for follow-up office visits and lab tests to monitor the mother’s progress and health status during pregnancy; goals for behavioral treatment, social and family engagement, or mutual-aid group meeting attendance;
  • opportunities for involvement of family members or significant others in treatment;
  • symptoms that should be reported to the prescribing physician;
  • safety planning (injury and violence prevention)
  • a plan for treating co-occurring medical or psychiatric conditions, as well as other SUDs including tobacco; and expectations for maintenance of pharmacotherapy and engagement in other therapies and, if needed, more intensive levels of care.

Upon birth, the baby’s symptoms will be scored regarding the severity of the NAS symptoms; in some cases, the baby will need medication in the form of methadone, under close supervision,

“Babies don’t automatically need to go to the Neonatal Intensive Care Unit; it depends on where they fall on the scale for their symptoms and response to medication. Ideally, mom and baby are not separated, and mom can respond to baby’s needs to be fed and be consoled.”

Having baby in mother’s room is encouraged, as are breastfeeding, cuddling, and soothing in a low stimulation environment, says Dr. DeRoo.  Most NAS babies are in withdrawal so they are difficult to soothe and may cry for long periods of time. It’s important that hospital staff be supportive of new mothers with NAS babies. “Support the mom. She doesn’t need to be shamed; she needs your help as a provider. She wants to learn how to best care for her baby.”

The discharge plan for NAS babies should include home visitation and early intervention services, such as including attachment-based parenting support, a home nursing consult, a social work consult and referrals to healthcare professionals who are knowledgeable about NAS and are accessible to the family immediately after discharge.

Understanding risk factors for both the caregiver and infant are important for prevention of injury and violence, including issues of personal safety, lack of parenting skills, inadequate food or housing. All can contribute to the return of substance abuse and injury to the infant.