The Neonatal Intervention Group has identified Neonatal Withdrawal, also called prenatal substance exposure syndrome (PSES), as its initial point of emphasis, having a very large impact in Utah for both women and newborns.
Neonatal Withdrawal includes both neonatal withdrawal from opiate drugs (neonatal abstinence syndrome (NAS), as well as CNS irritability symptoms from discontinuation of maternal benzodiazepines and barbiturates, stimulants (cocaine, amphetamines), SSRIs/SSNRIs, marijuana, tobacco or alcohol. In a recent prevalence survey in Utah(2), 6.8% of umbilical cord samples were positive for one or more substances of abuse. Opiates were the most frequent (4.7%). Also noted were barbiturates, benzodiazepines, alcohol, marijuana, methamphetamine, and cocaine.
In the past, each hospital within the state has had individual approaches to identifying newborns at risk for withdrawal. Over the past year and a half, the University of Utah and the Intermountain Healthcare Women's, Pediatric and Neonatal substance abuse teams have been meeting regularly and have standardized algorithms for identification of the drug-exposed newborn, "sensitive care" to minimize symptoms of withdrawal and CNS irritability, use of a score to identify newborns in need of medication for NAS, a standardized oral morphine treatment schedule as well as adjunctive medication therapies for those newborns not weaning from morphine or those with CNS hyperirritability following exposure to multiple classes of maternal medications.