Kayla gave birth to Baby M after a pregnancy complicated by multiple substances. Baby M was born small for gestational age (weight 4.4 pounds and other growth parameters below the 10th percentile) at 38 weeks gestation. Because of the mother’s positive urine toxicology screen, the nursery team was alerted to be vigilant for symptoms of Neonatal Abstinence Syndrome (NAS). Kayla was discharged by her physician on postpartum day two. Baby M remained hospitalized due to concerns about potential NAS.

Since his birth, Baby M was assessed by hospital staff for symptoms of NAS. Instead of using the traditional Finnegan scoring system, the hospital used a functional-based scoring system which included evaluating Baby M’s ability to eat well, sleep for an adequate period of time, and be consoled easily. He was able to remain in Kayla’s room where she could provide all his care using non-pharmacologic measures including breastfeeding, skin-to-skin contact, and maintaining a non-stimulating environment. Initially Baby M remained calm with these non-pharmacologic measures, but as Kayla’s discharge approached, Baby M began to feed poorly and was difficult to console. When Kayla was discharged, Baby M moved to a private room where Kayla could continue to stay and care for him as he continued his monitoring and treatment for NAS. Baby M required two PRN morphine doses to ease his symptoms, after which his functional assessments improved. After his last PRN morphine dose, he was monitored for a day and a half without symptoms before being discharged. Prior to his discharge, the hospital pediatrician spoke with the outpatient pediatrician who would be assuming Baby M’s care to discuss his hospital course and plan for follow-up visits.