Post-discharge management and prognosis

Infants with NAS usually are observed in the hospital for four to seven days.2However, because evidence of withdrawal may be delayed until five to seven days after birth and after hospital discharge, outpatient follow-up should take place early, and parents or caregivers should be advised of the signs of late withdrawal.2,4,8

Whether infants are breastfed or formula-fed, parents should be given appropriate information and support regarding feeding to ensure their ongoing involvement with infant care.10Parents who formula-feed should be educated about safe practices for the preparation, transportation, and storage of prepared infant formula as well as appropriate methods for heating or reheating reconstituted prepared formula.10

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The class of drug used during pregnancy may affect the infant’s CNS development, cognitive function, and behavior as he or she grows (Table 3).19Antenatal use of tobacco is associated with a lower IQ for the child as well as aggression, antisocial behavior, and attention deficit/hyperactivity disorder (ADHD),19while the developmental effects of fetal exposure to tetrahydrocannabinol (THC) manifest as impairment of executive function and difficulties with reading and spelling.19

Infants born to mothers who used cocaine may exhibit a general cognitive delay and inhibited information processing; as children, they may be small for their age, have problems with attention, and exhibit disruptive behaviors.19On the other hand, fetal exposure to methamphetamine does not appear to produce mental or motor delays in infants and toddlers.19

Infants exposed to opiates antenatally may have delays in general cognitive function and may experience anxiety, aggression, and disruptive or inattentive behavior as children.19

Relatively few studies on long-term outcomes in infants with NAS have been performed. Confounding variables that may affect outcomes include unsafe/unhealthy home environment, dysfunctional caregivers, fetal growth restriction, and polydrug exposure.