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 the 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. The goal should be accomplished in a safe, compassionate environment designed to be inclusive for the mother and her newborn. The mother's ability to assist in the care of her infant has positive effects on both mother and newborn and leads to enhanced bonding and parenting. If the mother cannot 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. Like the Finnegan Neonatal Abstinence Scoring System, a standard assessment tool should be initiated within the first two hours of life and performed every four hours until discharged from the hospital. Nurses caring for mothers and their newborns after birth must be highly trained on these tools. The tool assesses the severity of the withdrawal and the effects of individualized adaptations to care. When postpartum nurses have an increased understanding and knowledge of their institution's chosen assessment tool, they can better 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 nurse uniquely designed the nursing care based on the infant's behavioral symptoms to minimize withdrawal symptoms. Environmental modifications include dim lighting, quiet, limited handling, stimulation, cotton linens, soft music or white noise, swaddling, and aromatherapy. These modifications address the hypersensitivity NAS infants experience to external stimuli. They assist in reducing hyperactivity and help the infant organize their behaviors. Non-nutritive sucking, frequent smaller feeds, diaper creams, and frequent diaper changes can assist in minimizing the gastrointestinal side effects associated with NAS. Breastfeeding should be encouraged for mothers taking prescribed opioids, methadone, or buprenorphine. Breastfeeding may reduce the severity of the NAS symptoms and the need for pharmacologic treatment. Breastfeeding provides 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 treat diaper dermatitis and should be used at the earliest signs of skin irritation. Kangaroo care should be performed when the mother can, which will assist the newborn in regulating their temperature, oxygenation, heart rate, and respiratory rate. Evidence supports the nurse caring for the mother-newborn dyad and encouraging rooming-in. Rooming-in is associated with improved breastfeeding outcomes, increased maternal satisfaction, and greater involvement in the 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 the clinical symptomology of NAS. The goal of the therapy is to mitigate the signs of withdrawal, seizures, fever, weight loss, and dehydration. Although guidelines suggest the preferred treatment method is opioid therapy, there is no 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 advantages and disadvantages, and recent research suggests that a standardized protocol for the pharmacological treatment of NAS is more important than which drug is used to treat it. Improved standardization of nursing assessment, standards of nursing care, pharmacological treatment plans, and weaning protocols lead to shorter durations of medication use and reduced length of hospitalization. Discharge planning of the NAS infant must involve a multidisciplinary team. The mother's health and her maternal functioning, mental health, substance abuse treatment, the home environment, and support systems must all be assessed. Healthcare providers should educate the mother on sudden infant death syndrome (SIDS), sleeping positions, ongoing substance use disorder treatment, infant signs of infection, and the traditional newborn education received during the postpartum period.
