It is often quite difficult to follow an AOD-using mother and her newborn after release from the hospital, and thus it is vital that the infant and the mother not be discharged too early.
According to the Newborn Assessment Score, most babies (96 percent) are symptom-free of withdrawal seizures by the third or fourth day after birth and might otherwise be ready to be discharged from the hospital.
However, a small but significant percentage of babies present with withdrawal seizures within 7 to 10 days after birth.
For this reason, it is important to closely monitor the drug-exposed infant to determine if he or she needs to remain in the hospital after 4 days.
Other medical, social, or environmental issues may further prolong the need for hospitalization (Doberczak et al., 1988).
The infant's discharge should occur after the following criteria are met:
The infant is taking oral feeds and gaining weight satisfactorily.
The infant is physiologically stable (has normal vital signs including blood pressure).
The infant is showing neurobehavioral recovery (can reach full alert state, responds to social stimuli, and can be consoled with appropriate measures).
All necessary assessments have been completed, since adherence to followup schedules cannot be ensured.
The parent(s) or alternate primary care provider should receive anticipatory guidance (oral and written) regarding late and subacute withdrawal, seizures, behavioral interventions, and medications (side effects, route of administration, dose, etc.).
A home evaluation should be performed on all drug-exposed infants or those with multiple risks by a public health nurse or a protective social service worker within 7 days of discharge, when feasible.
A follow-up appointment for pediatric care should be scheduled within 2 to 4 weeks.
Mothers and fathers who are not already enrolled in drug abuse treatment and need to be should be referred to an accessible and suitable treatment program prior to the infant's discharge.
Facilitation of mother's postpartum gynecologic care and family planning should be incorporated into discharge planning of the infant.
To promote quality improvement, discharge planning instructions should be documented in medical records, and a discharge summary of the hospital course should be given to parents or alternate primary caregiver.
The following chapter gives further guidance on proper monitoring and care of the drug-exposed infant following discharge from the hospital.
Drug abuse during pregnancy is associated with medical, psychological, and economic problems that require extensive evaluation by qualified service providers.
Mothers and fathers of drug-exposed infants need substance abuse treatment and a wide array of services to support them in their parenting role.
Provision must be made for such services prior to an infant's discharge. Chapter 4 contains recommendations regarding psychosocial services for families of drug-exposed infants.
1 The research documents aspects of neurobehavioral development in 36- and 48-month-old children.
At 48 months, significantly lower scores in verbal and memory domains were associated with maternal marijuana use after adjusting for confounding variables.
This negative relationship is the first reported association beyond the neonatal stage, and may represent a long-term effect of the drug upon complex behavior that, at a younger age, had not developed and/or could not be assessed.2 Information in this section is based on data from Pietrantoni and Knappel, 1991.
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