Supporting Infants Exposed to Substances Before Birth

Andrea Duncan, MD, MS and Barbara Chaiyachati, MD, PhD

The increase in opioid use disorder among adults across the U.S. includes pregnant people, with an associated increase in substance-exposed newborns. Resilience after Infant Substance Exposure (RISE) is a clinical care track within our Neonatal Follow-up Program (NFP) that provides specialized care for infants who have been exposed to substances, such as opioids, before birth.

Babies exposed to some substances before birth, including both prescription and non-prescription drugs, are at risk for developing neonatal abstinence syndrome (NAS) after they are born. For babies exposed to opioids, this condition may be called neonatal opioid withdrawal syndrome (NOWS). Symptoms of NOWS usually begin within days after birth and can last for months.

Symptoms range from mild to severe and can include:

• body shakes
• diarrhea
• excessive crying and fussiness
• trouble sleeping
• poor feeding
• breathing problems

Some babies are able to have their NOWS symptoms managed through environmental changes like calming sounds and lights as well as physical supports such as swaddling or rocking. Some infants do require treatment with medications such as morphine to support them. These medications are not long term and are gradually decreased in dose until they are stopped or weaned off. 

Why RISE? 

The Resilience after Infant Substance Exposure (RISE) Program brings together expertise across neonatology, pediatrics and early childhood development. Together, we take a compassionate and coordinated approach to identify and address the specific needs of each infant with NOWS and their family.

Our program prioritizes shared decision-making with families to ensure the best possible experience and outcome. Our team typically sees a baby for their first appointment at 6 to 8 weeks (about 2 months) of age. Regular appointments continue from infancy through age 5, depending on the baby’s needs.

Prenatal exposure to opioids may increase the risk for certain developmental differences including movement, learning and attention difficulties. We provide assessment and care along the trajectory of development to proactively support development and, if they arise, identify any differences early to facilitate appropriate response and connections.

If you would like to have a child seen by the RISE Program, please call 215-590-2183. To learn more, visit chop.edu/rise.