Nonmedical use and abuse of prescription drugs is on the rise in the United States, especially among those who are of childbearing age (National Institute on Drug Abuse [NIDA], 2014). The rate of babies born with neonatal abstinence syndrome (NAS) per 1,000 hospital births has increased from 1.2 in 2000 to 3.39 in 2009 and rate of maternal opiate use per 1,000 hospital births has increased from 1.19 in 2000 to 5.63 in 2009 (NIDA, 2012). Data are not yet available for the past 5 years; however, it is likely the rates have continued to increase. Nonmedical use of prescription opioids is likely related in part to overprescribing pain medications (NIDA, 2014). It is estimated that >2 million people in the United States have a substance use disorder related to prescription opioids (NIDA, 2014). Based on the most recent data available specific to maternal use and affected newborns, a baby experiencing opiate withdrawal is born at least every hour in the United States (NIDA, 2012).
Guidelines from the American College of Obstetricians and Gynecologists (ACOG, 2015) on alcohol abuse and other substance use disorders offer suggestions for maternal care and treatment such as routine screening for substance abuse disorder used in an equal manner for all patients, protection of patient confidentiality, nonjudgmental respectful care, and appropriate referral. Careful consideration when prescribing controlled substances is recommended. The American Academy of Pediatrics (AAP, Hudak, & Tan 2012) provides detailed guidelines on how to care for babies with intrauterine exposure to drugs and who are suffering effects of drug withdrawal including neonatal withdrawal syndrome (NWS) and NAS. Assessment in the first hours and days after birth is important in identifying babies with symptoms of drug withdrawal and beginning necessary treatment. The symptoms associated with opioid withdrawal are termed NAS (AAP et al.). Intrauterine exposure to opioids has serious negative implications for the newborn; 55% to 94% of these babies will develop symptoms of withdrawal (AAP et al.). Every perinatal service should have a plan for identifying women with substance abuse disorder, proper and timely family referral after discharge, and identification and care of babies with NAS or NWS through use of a published assessment tool (AAP et al.). It is a reasonable expectation that babies exposed to opioids in-utero be observed in the hospital for 4 to 7 days after birth (AAP et al.). Withdrawal symptoms may be delayed and not noted if the newborn is sent home in the usual 48 hours after vaginal birth.
Costs of care of babies with NAS can be considerable due to extended length of stay (LOS) and withdrawal treatment. Average LOS for newborns with NAS is 16.4 days compared to 3.3 days for those without NAS (NIDA, 2012). Average cost of hospital care for newborns with NAS was $53,400 compared to $9,500 for those without NAS based on 2009 dollars (NIDA).
The increased LOS may present major staffing challenges, especially for units that generally provide care for healthy mothers and babies. In these units, babies are likely to be in the postpartum room with their mothers and the newborn care provided at the mother's bedside. Staffing a well-baby nursery with a registered nurse to care for one newborn with NAS or NWS after the mother has been discharged can negatively affect overall unit staffing and productivity budgets.
As maternal use and abuse of opioids and other prescription drugs increases, we must develop plans for safe care in the inpatient setting for babies with NAS or NWS. Based on the population served and recent history of positive maternal and newborn drug screens, predictions can be made for staffing needs and staffing budgets adjusted accordingly. Referral and follow-up for the mother and baby are needed after discharge. Perinatal nurses can make important contributions to the clinical response to this growing public health issue.
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