Resilience After Infant Substance Exposure (RISE) Program

Resilience after Infant Substance Exposure (RISE) is a partnership between the Neonatal Follow-up Program (NFP) at Children’s Hospital of Philadelphia (CHOP) and social workers and caretakers in the community. Together, we provide specialized care for infants with prenatal opioid exposure who may have experienced neonatal opioid withdrawal syndrome (NOWS).

Rising to the challenge

According to local and national statistics, the number of infants born with prenatal substance exposure, including those at risk for and impacted by NOWS, is on the rise, in line with the opioid epidemic trends at large. Philadelphia, in particular, is significantly affected by substance use by multiple measures.

At CHOP, we recognize that tackling the issue of substance use during pregnancy requires a collaborative approach that brings together experts in health, substance use treatment, child welfare, and early childhood development to identify and provide interventions for the multifaceted needs of the infant, parents, caregivers and family members.

Recognizing prenatal opioid exposure

Infants exposed specifically to opioids may experience neonatal opioid withdrawal syndrome (NOWS). This syndrome refers to the physical symptoms that babies may develop after birth if they have been exposed to opioids, including either prescription and non-prescription opioids, before they are born. After the baby is born and is no longer exposed to opioids, their own body must transition to this new condition. The transition phase sometimes includes physical symptoms that can be similar to some symptoms of substance withdrawal described in adults. This transition can be caused by many different types of drugs, including opioids.

It is difficult for healthcare professionals to predict which babies will have a hard time transitioning or meet a diagnosis of NOWS prior to or even at birth. The symptoms usually begin after birth, within two to three days, and can last up to six months.

The symptoms of NOWS range from mild to severe and can include:

  • Body shakes
  • Excessive crying and fussiness
  • Fever
  • Diarrhea
  • Trouble sleeping
  • Poor feeding
  • Breathing problems

Some babies are able to be supported with non-pharmacologic interventions from their parents or nurse. This type of care may involve soothing symptoms through swaddling, rocking or skin-to-skin contact. Some infants do require treatment with medications such as morphine to support them. These medications are not long term and are progressively decreased in dose until they are stopped or weaned off.

Long-term outcomes

Research suggests that prenatal exposure to many substances such as alcohol and tobacco may cause a spectrum of physical and developmental differences from growth and behavior to cognition and language. Research is still ongoing to understand the long-term impacts of NOWS and may include:

  • Speech problems
  • Learning difficulties
  • Memory issues
  • Hyperactivity

Reducing harm from prenatal opioid exposure

Preventing NOWS can only be done by preventing opioid exposure during pregnancy, which may or may not be safe or medically appropriate. For pregnant people who misuse or are addicted to drugs, NFP-RISE aims to reduce harm from prenatal opioid exposure and support engagement with recovery services to increase the likelihood of safe parenting.

Under the Division of Neonatology at Children’s Hospital of Philadelphia, NFP-RISE helps to coordinate unparalleled care across disciplines, specialties, primary care and community services. More specifically, the program:

  • Delivers integrated care designed to decrease risk and optimize outcomes by utilizing best practices for serving this population as established in November 2020 by the American Academy of Pediatrics (AAP).
  • Includes innovative approaches to engage and establish a connection with caregivers early, including prenatally.
  • Is grounded in a supportive, non-punitive framework for caregivers and babies, which aligns with federally legislated plan-of-safe-care (POSC) mandates for birth hospitals.
  • Monitors participants to identify areas of need early and connect infants and young children to therapeutic interventions. In situations of custodial disruption, we leverage team connections across community services including child protective services — for example, Philadelphia’s community umbrella agencies (CUAs) and Department of Health Services (DHS) nurses — to facilitate continuity of care for infants across caregiving situations.

It is likely that stigma or fear of punitive interventions postnatally keep pregnant people from seeking care or disclosing their substance use. This may be even more of a barrier in minority racial groups, an issue that may originate from longstanding racial disproportionality in the child welfare system. NFP-RISE hopes to dismantle these disparities through non-stigmatizing provision of care that incorporates lived experience expertise.

A welcome resource

The compassionate and coordinated care provided through NFP-RISE has been developed in collaboration with other CHOP providers, other hospitals and community stakeholders. 

CHOP is consistently recognized as a national leader in the advancement of healthcare for children. NFP-RISE puts CHOP at the forefront of this community health issue. Given time, our hope is that NFP-RISE will emerge as a national model for the care of NOWS infants and young children.

Help is Available

If you think you are pregnant or might become pregnant, and you are using opioids, it is important to discuss this with your doctor. A range of prevention, early intervention and treatment efforts can improve outcomes for infants and families.