Kayla continues to care for Baby M with breastfeeding, holding skin-to-skin, and minimizing overstimulation. A nurse assesses Baby M and notes at 2 days old that he is unable to sleep for at least one hour after feeding and has continuous crying. The nurse confirms that both she and Kayla have had difficulty consoling Baby M and that at the time of the last assessment he was still crying after 10 minutes of attempts at consolation. He also has moderate tremors when disturbed, a hyperactive Moro reflex, and nasal stuffiness. The nurse assists Kayla with trying to optimize non-pharmacologic interventions, but Baby M continues to have poor sleep and persistent crying. Kayla and the medical team discuss the situation and, given their concern for functional impairment, Baby M is moved to an inpatient room where he is given one dose of PRN morphine by mouth and placed on a cardiorespiratory monitor. Medical staff have recently worked with hospital administrators to ensure newborns with NAS can be placed in private rooms to preserve the mother/baby dyad. After Kayla is discharged, she can stay with him and continue to provide his care.
Non-pharmacologic measures continue to be optimized. After feeds, Baby M is occasionally irritable, but with swaddling and holding he soothes quickly. Once soothed, he sleeps until the next feeding. He requires one additional dose of PRN morphine the following day for poor feeding and inconsolability, after which his symptoms do not recur. He completes a period of monitoring without medication for a day and a half, with Kayla providing all of his care. Baby M is discharged home to Kayla with close follow-up from the outpatient pediatrician.