The treating physician within the hospital setting should communicate directly with the outpatient primary care provider (pediatric or family medicine provider) prior to the newborn leaving the hospital to review the hospital course, inform the primary care provider of social issues, discuss feeding plans, and ensure timely follow-up appointments are available within 24–72 hours of discharge from the hospital. In addition to the primary care provider, scheduling of home visit(s) by a nurse and/or social worker is ideal if available (see Best Practices #25, #29 and #31).
Why we are recommending this best practice
- Newborns exposed to illicit or non-medicinal uses of substances during pregnancy are at risk of withdrawal, as well as ongoing neurodevelopmental and other challenges. They require high risk or other close follow-up care to ensure early identification of and intervention for potential adverse outcomes.
- Primary care providers should be aware of the current feeding regimen to ensure that the newborn continues to receive adequate caloric intake for growth and development and to adjust as necessary.
- Newborns who are initially breastfed by women on medication assisted treatment (MAT) and whose mothers stop breastfeeding may be at higher risk of experiencing a recrudescence of withdrawal symptoms. Although the risk is minor, as breastmilk concentrations of both methadone and buprenorphine are low, primary care providers should be informed.
- Subacute signs of neonatal abstinence syndrome (NAS) may last up to six months.
- Drug exposure in utero is a marker of environmental risk. Caretaker involvement, family resources, and community resources are protective factors that can improve long-term outcomes for children.
Strategies for implementation
Consider a NAS discharge checklist for inpatient providers and primary care providers caring for exposed newborns, which should ideally be incorporated into the electronic health record.
Baby M no longer needs pharmacologic therapy and will be ready to go home soon. In preparation for that transition, the pediatrician who has cared for Baby M in the hospital calls the pediatrician who will care for Baby M as an outpatient. During the phone call, the pediatrician describes Kayla and Baby M’s social and medical history, summarizes the hospital course, and suggests all aspects of care after discharge.
- Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarko L, Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid- exposed infants. Acta Paediatr. 2013;102(11):1060-1066.
- Messinger DS, Bauer CR, Das A et al. The maternal lifestyle study: cognitive, motor, and behavioral outcomes of cocaine-exposed and opiate-exposed infants through three years of age. Pediatrics. 2004;113(6):1677-1685.
- Bada HS, Bann CM, Whitaker TM et al. Protective factors can mitigate behavior problems after prenatal cocaine and other drug exposures. Pediatrics. 2012;130(6):1479-1488.