When a newborn who is exposed to opioids in utero does not require pharmacotherapy and is managed solely with a non-pharmacologic bundle of care, we recommend a minimum of 72 hours of inpatient monitoring.
Why we are recommending this best practice
Opioid clearance in newborns is variable due to patient clearance characteristics, type of opioid, and the presence of other drugs. Most newborns will present with withdrawal symptoms by 24–72 hours, depending on the half-life of the opioid used by the mother and the potential for exposure to multiple substances. Inpatient monitoring is important to allow for potential symptoms to present and for the newborn to receive the appropriate treatment.
Strategies for implementation
- A recommended observation period should be included in each hospitals’ written guidelines.
- Documentation of potential opioid exposure should be included in the medical record to provide medical necessity justification when the observation period exceeds the otherwise expected length of stay.
- Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134(2):e547-561. doi: 10.1542/peds.2013-3524.
- Hudak ML, Tan RC. Neonatal drug withdrawal. Pediatrics. 2012;129(2):e540- 560. doi: 10.1542/peds.2011-3212.
- Seligman NS, Salva N, Hayes EJ, Dysart KC, Pequignot EC, Baxter JK. Predicting length of treatment for neonatal abstinence syndrome in methadone-exposed neonates. Am J Obstet Gynecol. 2008;199(4):396.e1-7. doi: 10.1016/j.ajog.2008.06.088.