Improving Treatment for Drug-Exposed Infants
Treatment Improvement Protocol (TIP) Series 5

Physical Examination

A thorough physical examination of the neonate should include accurate assessment of weight, length, and head circumference and a standardized assessment of gestational age. Special attention should be paid to signs of intrauterine growth retardation, microcephaly or decreased head circumference, prematurity, congenital infection, and major and minor congenital malformations. Various tools and scoring systems can be used to chart and compare the infant's neuromuscular and physical maturity and size to normal ranges for infants (Ballard et al., 1977; Ballard et al., 1979; Brazelton, 1984; Lubchenco et al., 1966). The Newborn Maturity Rating and Classification chart is reproduced in Exhibit 1.

Screening for Congenital Infection

Drug-exposed infants are at increased risk of acquiring infections transmitted from mothers whose lifestyles include unsafe sexual practices or intravenous drug abuse. Assessment of the mother for sexually transmitted diseases and human immunodeficiency virus (HIV) should be incorporated into the prenatal care setting and delivery hospitalization.

1. Quality improvement guidelines should be established within each institution to assess periodically the prevalence of HIV infection among pregnant women anonymously screened on a random or consecutive sample population.
2. AOD-using pregnant women should receive routine screening for syphilis, hepatitis B, gonorrhea, and chlamydia.
3. AOD-using pregnant women should be offered confidential or anonymous screening for the HIV-1 virus with appropriate pre- and post-test counseling.
4. Quality improvement guidelines should be established within each institution to review the incidence of sexually transmitted diseases among pregnant women and their impact upon the infants and the health care delivery system.
5. Quality improvement guidelines should be established within each institution to ensure utilization of updated recommendations for medical management of neonates exposed to HIV, hepatitis B, syphilis, gonorrhea, and chlamydia (Prober and Gershon, 1991).
6. Quality improvement guidelines should include universal precautions for infection control in the delivery service and neonatal nurseries.