Neonatal abstinence syndrome (NAS) rates and costs have skyrocketed across the U.S. in recent years.
NAS occurs when a dependent newborn is no longer exposed to substances used by the mother during pregnancy—its epidemic is alarming both because of the severity of the newborn’s medical withdrawal experience and because the majority of NAS cases are covered by Medicaid, a publicly provided state health insurance program. South Carolina falls into one of the country’s geographic regions with the highest NAS rates.
Varying Treatment Modalities
Observation and treatment protocols vary by institution, state and country. The conventional U.S. approach to NAS is to manage infants with comfort care while withholding pharmacologic treatment until a clear NAS diagnosis is made. Once an internal threshold for treatment has been reached, medication is typically provided in a high-acuity nursery and does not include an outpatient weaning component.
In 2003, Greenville Health System in South Carolina (GHS) launched the Managing Abstinence in Newborns (MAiN) program, which provides multidisciplinary community-based care for NAS infants and their families within a Mother Baby Unit. MAiN’s three essential elements include:
- early treatment for infants at highest risk for opioid withdrawal (i.e. low-dose methadone treatment started within 48 hours of birth)
- option to room-in with the mother for the entire birth hospitalization
- combined inpatient/outpatient weaning