Substance-Exposed Newborns: Information for Pediatric Healthcare Professionals

Substances such as alcohol, cannabis, opioids, and stimulants ingested or inhaled during pregnancy can affect a woman's health and the health of her fetus. These substances can be detected prenatally or in a baby at birth through a drug test, diagnosed if the baby has symptoms of withdrawal, or discovered if prenatal substance use is self-reported.

Newborns exposed in utero to any opioid-containing substance may experience withdrawal symptoms like tremors, excessive crying, and difficulty feeding after delivery. Such substances include prescribed opioids for pain, opioid agonists for treatment of opioid use disorder (OUD), and illicit opioids such as heroin or fentanyl.

The medical term for withdrawal symptoms in a newborn is Neonatal Abstinence Syndrome (NAS). NAS-like symptoms can sometimes be a result of withdrawal from medications like antidepressants and benzodiazepines, and NAS risk may increase when these medications are combined with smoking. In Rhode Island, the rate of Neonatal Abstinence Syndrome has decreased over the past decade.

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who was prenatally exposed to alcohol. There is no known safe amount of alcohol during pregnancy. FASDs can include physical, behavioral, and learning problems.

What we are doing

Consistent with national laws, Rhode Island’s Plan of Safe Care (POSC) process is intended to support substance-exposed newborns and their adult caregivers. In Rhode Island, a Plan of Safe Care is called “Your Circle of Care Plan” (CoC) and includes current and new biopsychosocial referrals for substance-exposed newborns and their adult caregiver. Biological parents may accept or decline CoCs. Foster parents may not decline CoCs.

Each CoC is tailored to the unique needs of the family. The Perinatal Substance Use Program manages the CoC process and  individuals and families may be referred to RIDOH-sponsored programs like Family Visiting and Women, Infants, and Children (WIC).

RIDOH reports the following aggregated and de-identified data to the Rhode Island Department of Children, Youth & Families (DCYF): (a) the number of substance-exposed newborns; (b) the number of CoCs offered; (c) the number of CoCs consented to; (c) the numbers and types of referrals. Per federal legislation, DCYF is the agency that reports the overall numbers to the Federal Administration for Children and Families.

What pediatric healthcare professionals should do

If you’re a healthcare professional who works at a birthing hospital and a substance-exposed newborn is being discharged to their birth parent(s), you must offer them a Family Circle of Care Plan.

For substance-exposed newborns being discharged to foster care, pediatric healthcare professionals must complete a Foster Circle of Care Plan with the foster parents. These plans should become part of the infant's hospital medical record.

If you are a community-based pediatric healthcare provider, referrals made through a CoC may be accessed on KIDSNET.