NEONATAL ABSTINENCE SYNDROME
Healthpark Medical Center
  1. OUTPATIENT (Maternal)
    1. Mothers from PAR may have the history available.  Call PAR for records, if not readily available. (Phone #)
    2. Pain Clinics (Phone #)
  2. INPATIENT
    1. Obstetric Floor: (If drug withdrawal is suspected)
      1. Admit to PCN or Pediatric ward if mother is a known or documented narcotics addict
      2. Perform the modified Finnegan score[DLC1] ; if score is:
        1. greater or equal to 8, Call the Baby’s physician for transfer to PCN or Pediatric ward
      3. If not admitted, obtain the following:
        1. Maternal History specially:
          1. Psychosocial history
          2. Drug screen
        2. Continue modified Finnegan scoring every 8 h
        3. Do not discharge until at least 72 hours of age and the score is <5.[DLC2] 
        4. Prior to discharge be sure that the following has been done:
          1. Urine or meconium drug [DLC3] screen; order needs to state that results to go to primary pediatrician.
          2. Social service consult and/or
          3. DCFS notification[DLC4] 
          4. Home health visits 3 times per week. (To also do scoring)
    2. Special Care Nursery:
      1. Routine step down nursery admission orders.
      2. Obtain maternal history specially:
        1. Psychosocial history
        2. List of drugs abused/doses/dates
        3. Drug screen results/dates
      3. Do modified Finnegan scoring 30 to 60 after every q 3 to 4-hour feedings.
      4. For modified Finnegan score of =8 or average of 8 for 3 consecutive periods:
        1. Comfort Measures
        2. Pharmacotherapy:
          1. Phenobarbital
          2. Morphine Sulfate
          3. Combination of Morphine & Phenobarbital
      5. Social service consult, including DCFS notification
      6. Discharge only when the following done:
        1. 48 hours off morphine with a consistent score of <5
        2. After successful nesting
        3. Favorable Social service report
        4. Favorable DCFS recommendation
        5. Pediatrician notification and acceptance.
        6. Maybe discharge on Phenobarbital as long as off morphine as indicated above
        7. Proper Home health, CMS and Healthy Start agencies are ready
        8. Neurodevelopmental follow-up and Early Intervention program referral
      7. Follow-ups:
        1. Pediatrician 1 week unless desired earlier
        2. Home health services daily for 2 weeks; scoring to be done each visit; report to attending Pediatrician.
        3. OT/PT twice weekly for 2 weeks
        4. DCFS will schedule their own visit, if needed
        5. Neurodevelopmental evaluation and Early Intervention program. 

 [DLC1] Whatever is decided. The scoring from Oakland looks attractive.  

 [DLC2] Choice is mine. Nothing in literature to indicate the right or wrong choice.

 [DLC3] Dr. Borrego still does not know where to send them; let alone what the turn-around time.

 [DLC4] Notification instead of reporting is emphasized.