The care of the newborn at risk for or diagnosed with NAS must be delivered by a nonjudgmental multidisciplinary team trained in the management of maternal substance use disorder and NAS. Social services and healthcare providers must work together to care for newborn mother dyad during their hospital stay and outpatient care. The goal of the care is to promote maternal-infant bonding, normal growth, and development, and minimize signs of NAS expression. This should be accomplished in a safe, compassionate environment designed to inclusive and the mother and her newborn. The mother’s ability to assist in the care of her infant has positive effects for both mother and newborn and leads to enhanced bonding and parenting. If the mother is unable to provide care to her newborn, the family should be incorporated into the place of care.
Since the signs of withdrawal can begin almost immediately after birth, all healthcare workers must know how to assess these newborns. A standard assessment tool, like the Finnegan Neonatal Abstinence Scoring System, should be initiated within the first two hours are life and then performed every 4 hours until discharged from the hospital. Nurses caring for the mothers and their newborns after birth must be highly trained on these tools. The tool is used to assess the severity of the withdrawal, as well as the effects of individualized adaptations to care. When postpartum nurses have an increased understanding and knowledge of their institution’s chosen assessment tool, nurses are better able to determine which symptoms can lead to an earlier diagnosis and treatment plan.
Nursing care for this vulnerable population includes both nonpharmacologic and pharmacologic therapies. The nursing care is uniquely designed by the dyad nurse based on the infant’s behavioral symptoms with the goal of minimizing withdrawal symptoms. Environmental modifications include dim lighting, quiet, limit handling, and stimulation, use of cotton linen, playing soft music or white noise, swaddling, and aromatherapy. These modifications address the hypersensitivity NAS infant experience to external stimuli. They assist in reducing hyperactivity and help the infant organize their behaviors. Non-nutritive sucking, frequent smaller feeds, using diaper cream, and frequent diaper changes can assist in minimizing the gastrointestinal side effects associated with NAS. For mothers taking prescribed opioids, methadone, or buprenorphine, breastfeeding should be encouraged. Breastfeeding may reduce the severity of the NAS symptoms and the need for pharmacologic treatment. Breastfeeding also provides a more easily digestible milk in small and more frequent on demand feeds.
Nurses who assess infants with jitteriness, myoclonic jerks, excessive moro reflexes, and neurologic hypersensitivity can use treatments that may help the newborn relax. These treatments can include Reiki, infant massage, and swaddling. Swaddling also helps skin excoriation due to excessive rubbing, thereby reducing trauma to the skin. Topical barrier creams help to treat diaper dermatitis and should be used at the earliest signs of skin irritation. Kangaroo care should be performed when the mother is able to, and this will assist the newborn in regulating their temperature, oxygenation, heart rate, and respiratory rate. Evidence supports the nurse caring for both the mother newborn dyad and encouraging rooming in. Rooming in is associated with improved breastfeeding outcomes, increased maternal satisfaction, and greater involvement in maternal care of the newborn.
In many cases, even with continued thorough nursing assessments and individualized non-pharmacologic care of the NAS newborn, a pharmacologic intervention has to be initiated. Pharmacologic therapy is designed to be a short term agent used to improve clinical symptomology of NAS. The goal of the therapy is to mitigate the signs of withdrawal, seizures, fever, weight loss, and dehydration. Although the Academy of Pediatric guidelines suggest the preferred treatment method is opioid therapy, there is not a universal standard of care, and variations in practice exist. Morphine and methadone are the preferred opioid formulations, morphine being a short-acting opioid, and methadone a long-acting opioid.
Each medication has an advantage and disadvantage, and recent research suggests that a standardized protocol for pharmacologic treatment of NAS is more important than which drug is used to treat. Improved standardization of nursing assessment, standards of nursing care, pharmacological treatment plans, and weaning protocols led to shorter durations of medication use and reduced length of hospitalization. Discharge planning of the NAS infant must involve the multidisciplinary team. The health of the mother and her maternal functioning, mental health, substance abuse treatment, assessment of the home environment, and support systems must all be assessed. Healthcare providers should be educating the mother on SIDS, sleeping positions, ongoing substance use disorder treatment, infant signs of infection, as well as the traditional newborn education received during the postpartum period.