In order to avoid separation of mother and baby, those mothers of babies receiving treatment for NAS should be accommodated in the postnatal wards or in a designated transitional care area for up to 10 days, and occasionally longer in individual cases (6). It is not possible to predict the development of NAS in individual babies, and so babies should generally not be discharged home before the 5 th day.
Higher doses of methadone are associated with polydrug use, and it is likely that pharmacogenetics also play a role (5). In Glasgow, the median dose of methadone at the time of delivery is around 30 - 50 mg. Mothers should perform all routine care, allowing the midwifery team to assess their parenting skills.Īudit (at Princess Royal Maternity) indicates that the single most important predictor of the infant developing significant NAS (and thus requiring pharmaceutical treatment) is the prescribed maternal dose of methadone at delivery. Infants at risk of NAS should be nursed in the postnatal ward with their mother unless any specific indication for admission to SCBU is present. If a post-birth conference is deemed appropriate, ideally this should be held within 5 days of birth (see discharge section). Mothers recognised to have problematic illicit drug use during pregnancy are reviewed in the antenatal clinic by the social work team and their care is coordinated by the SNIPs team.Īt approximately 32 weeks’ gestation a multi-disciplinary care planning meeting will be arranged with the aim of performing an assessment of risks to the unborn child and drawing up a family support plan. Maintenance treatment is prescribed to stabilise lifestyle and mothers are encouraged to reduce this medication as tolerated. Overall, there is insufficient evidence that either maintenance treatment is superior (3,4). Buprenorphine use has been associated with less illicit drug use, higher birth weight and milder NAS, but retention within a treatment programme is less, compared to methadone.
The standard management of pregnant opioid dependent women includes prescription of either methadone or buprenorphine maintenance.
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