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
- 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.