Health care providers at Barnes-Jewish Hospital and St. Louis Children’s Hospital have developed a standardized approach to screening for opioid use in pregnant women and care for opioid-exposed newborns.
“Our goal is to provide the best possible care for both mothers and babies in an unbiased way,” says Sherrie Hauft, MD, a Washington University neonatologist at St. Louis Children’s Hospital. “It’s great if women self-report opioid use, and we encourage them to do so,” she says. “But this may not happen, and studies show that having standardized criteria for opioid testing reduces bias among health care providers and helps us provide better care for mothers and babies."
Under the new guidelines, all women admitted to labor and delivery are asked about current and past medications and drug use. The guidelines also recommend a risk-based approach for drug screening rather than universal screening. Some of the risks include absent or late prenatal care, history of drug use, placental abruption and erratic behavior.
“Those who test positive include women taking opioid medications as prescribed by their doctor, as well as others using illicit opioids or abusing legal opioids,” Hauft says.
The guidelines also recommend drug screening of urine and meconium samples in infants whose mothers use opioids. These infants may develop neonatal abstinence syndrome (NAS). Signs of NAS include tremors, irritability, wakefulness, fever, skin mottling, mild elevations in respiratory rate and blood pressure, poor feeding and diarrhea.
“We watch closely for signs of NAS,” Hauft says. “Some babies may need to be monitored in the hospital’s newborn intensive care unit (NICU) for up to a week after delivery. For those who need treatment, our primary medication is morphine. We use this drug to diminish the symptoms of NAS that can otherwise be life-threatening.”
All newborns exposed to opioids in utero, including those who do not experience NAS, receive non-pharmacologic interventions. These include allowing the infant to room in with the mother; keeping the lights low and the room quiet to avoid overstimulation; swaddling; skin-to-skin contact; frequent, on-demand feedings; and breast-feeding in cases where the mother is not using potentially harmful drugs.
The guidelines were developed by a team of specialists, including pediatricians, obstetricians, nurses, therapists and social workers. Hauft notes that the guidelines are evidence-based and aim to provide objective criteria for screening and management.
“Generally, the more we can standardize our approach to screening, patient care and the availability of resources, the less potential we have for bias. We want our families to know that we are not trying to label them or separate them from their child; we are working to provide the best care possible for the babies and families.”