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Brian Hidalgo

A clinical report recommends how to improve health outcomes for infants born with neonatal opioid withdrawal syndrome.

The U.S. opioid crisis has profoundly impacted pregnant mothers and infants. Mother and infant face considerable barriers to evidence-based treatment and care, which vary substantially based upon where they live.

In a newly released clinical report, the American Academy of Pediatrics provides an overview of why systemic, enduring, coordinated and holistic approaches are needed to improve care for mother and child affected by opioid use in pregnancy. The report, “Neonatal Opioid Withdrawal Syndrome,” is published in the November 2020 Pediatrics (published online Oct. 26).

“The escalation of opioid use over the past two decades has devastated families, resulting in more infants being diagnosed with opioid withdrawal shortly after they are born,” said Dr. Stephen W. Patrick, MD, MPH, MS, FAAP, lead author of the report, which was written by the Committee of Fetus and Newborn and the Committee on Substance Use and Prevention.

“We can take steps to improve healthcare for the mother during pregnancy, which leads to better outcomes for both mother and child, and, ultimately, for society. We saw an increase of 10,000 children in the foster care system from 2011 to 2017 largely due to a parent’s substance use, for instance. We must provide these families with support earlier, rather than later,” Dr. Patrick said.

The incidence of neonatal opioid withdrawal syndrome (NOWS), formerly called neonatal abstinence syndrome, rose from 1.2 to 8.8 per 1,000 hospital births between 2000 and 2016.

The AAP clinical report offers detailed recommendations for improving medical treatment and access; prenatal counseling and screening; observation of infants and their diagnosis, treatment, and discharge of the infant. Among the recommendations:

  • All pregnant women should have access to medications for opioid use disorder, which have been shown to reduce risk of overdose death and improve pregnancy outcomes.
  • Pediatricians should partner with state and local welfare agencies to advocate for funding to improve access to quality treatment for maternal opioid use disorder.
  • Pregnant women with opioid use disorder should receive counseling to provide education on the clinical signs of withdrawal and enhance their understanding of treatment, including breastfeeding and medications.
  • All hospitals should have standardized approaches and protocols to guide their management of opioid-exposed infants to reduce variability in the care they receive.
  • For infants of women in treatment between 30 and 90 days without relapse, breastfeeding should be considered.
  • All chronically exposed infants should be observed for at least 72 hours to monitor for the symptoms of withdrawal. Infants should be observed again at 3-7 days depending on if the infant was exposed to immediate-release opioids, buprenorphine and sustained-release opioids or methadone.
  • Hospitals should prioritize keeping the mother and infant together throughout observation and treatment. Rooming-in is the preferred model of care.
  • Hospitals should standardize their discharge processes to ensure infants are connected to post-discharge services including early intervention services, home nurse visitation and Early Head Start.

“Families will need continued support and education on opioid withdrawal, newborn care and safe sleep practices,” said Wanda D. Barfield, MD, MPH, FAAP, Director, Division of Reproductive Health at the Centers for Disease Control and Prevention and a coauthor of the report. “The pediatrician is there to help and can follow up to ensure a safe, coordinated transition home as well as other forms of support, such as counseling and connections to community resources.”


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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