How Hospitals Are Transforming Care for Newborns With Neonatal Abstinence Syndrome

AS A PUBLIC HEALTH crisis, the opioid epidemic has touched many lives and necessitated an urgent upheaval of what we thought we knew about treatment, especially for newborns with neonatal abstinence syndrome. By reducing the stigma surrounding NAS, doctors and medical providers can better care for mothers and their newborns and even reduce the length of their hospital stay. With the following improvements, we can offer partnership to new parents and work toward achieving happy, healthy families.

Changing Attitudes

One of the first steps in revolutionizing care for infants with NAS is to adjust common perceptions of mothers battling addiction. By destabilizing the idea that a parent is a bad parent if his or her child is born with this disease, we can encourage a nonjudgmental environment that feels safe for families. My colleagues and I at Nationwide Children's Hospital do this by using neutral, judgment-free terminology, involving parents in the care of the newborn as much as possible and incorporating social work consultations and follow-ups.

Because many mothers with addiction have backgrounds of abuse and trauma, it's important that the medical staff adopt training that will better help them interact with families. We should also be aware that not all mothers with babies born with NAS are actively addicted; some babies are born to mothers using opiates under the supervision of physicians for illness or injury. With this training, we can ensure that all families are getting the responsive care they need for a variety of situations.

Streamlining Care

Babies with NAS typically require longer hospital stays than babies born without withdrawal symptoms. Traditionally, many hospitals use the Finnegan scale to assess babies who were exposed to opiates in utero. However, we've realized that this scale alone doesn't reflect the complexities of babies with NAS today. By adopting new ways to assess the wellbeing of infants, like the Eat, Sleep, Console, Weight method, we're beginning to see changes that allow for partnership in care that can improve the outcome for babies.

Our protocols optimize non-pharmacological treatments like breastfeeding, skin-to-skin contact, quiet environments and dim lighting. If needed, a standardized pharmacologic approach that has been agreed upon by all clinical care providers is used to support the baby with NAS. These standardized protocols coordinated around patient needs have been successful in decreasing the length of stay and provide a less intrusive, streamlined plan of care.

Future of NAS Care

Of course, the transformation of NAS treatment continues to evolve. Some hospitals are even looking to move infants with NAS out of the hospital intensive care unit entirely to promote in-person bonding in a quieter setting. This program of care could even look like an extended stay for mothers and their infants as they receive medical support and care in a low-intensity setting.

Additionally, other programs focus on building out a system of prenatal and postnatal care. This includes prenatal care where moms-to-be receive medication-assisted treatment for their addiction, counseling and education about parenting and caring for babies with NAS in a comprehensive setting. During the third trimester, moms also meet with their doctor to discuss what to expect during the postnatal period. Methods like these require large efforts on behalf of training, collaborating and funding, but are poised to further change the regimen of care for infants with NAS and their families.

As hospitals adopt these transformative measures, mothers can access new ways to successfully manage their addiction and care for their newborn. By applying non-biased, streamlined care that looks at all aspects of a mother's and a baby's health, we can better ensure parents have the right resources to transition into their new lives after discharge and beyond.

Kristina Reber

If you or a loved one is suffering from addiction, alcoholism, or any co-occurring disorders please call us at (833) 818-3031 or visit