Discharge of Infants on Methadone for NAS
Weaning Protocol
A. Without the ability to use clinical guidance or Finnegan scores as outpatients, a
conservative approach to weaning should be undertaken:
1) 10% wean of original dose every other week for approximately 4 months
2) AAP recommends stopping methadone when the total daily dose is <0.03
mg/kg per day, which should coincide with doubling the birth weight by 4
months and the 10% every other week dose weans
3) The smallest measurable dose that peds pharmacy safely recommends is
0.1 ml which equals 0.1 mg. May stop methadone at this point even if mg/kg
dose is not <0.03 mg/kg per day. Also consider going to once daily at this point
for another 2 weeks.
B. Infants in Buncombe County discharged to Care Partners Home Health will have
intensive weaning managed by Care Partners nurse.
Recommendations for Monitoring Infants Exposed to Methadone at Risk for NAS
A. Infants should be monitored as inpatient for a minimum of 4-6 days for evidence of
withdrawal, recognizing that the symptoms of withdrawal from methadone may
not present until 4-6 weeks of life.
B. All infants prenatally exposed to methadone should have urine and meconium drug
screens
Discharge Criteria for Infants on Methadone
1) Discharge may happen once infant is stable without any changes in methadone dosing
for the previous 48-72 hours
2) Discharge may happen if Finnegan scores have been <8 for the previous 24-48 hour
period
3) Children requiring methadone due to illicit maternal use of narcotics (mom not in
treatment program or nor prescribed narcotic pills) are a high-risk subset of this highrisk population. Under these circumstances, DSS must be involved and a safe
discharge plan put in place. If this is not achievable, then the entire methadone wean
should be done as an inpatient.
4) All infants discharged home on methadone will receive (as available):
A. Home Health referral
Usually 2 times a week for the first 2 weeks, then weekly for 2-4 more
weeks. Indication is weight checks, withdrawal assessment and
medication administration.
B. Early Intervention Referral
C. Follow-up appointment at Neonatal-Toddler Follow-Up clinic at Mission
5) Appointment with primary care provider in 24-48 hours
6) Recommend follow-up with primary care provider every 1-2 weeks, with nurse visits for
weight check/symptom check on the off weeks
7) 1 month prescription for methadone at discharge dose
8) Weaning recommendations will be included with discharge paperwork faxed to
pediatrician
9) Be on only methadone (Phenobarbital should be weaned as inpatient)
10) Be on q12 methadone (q8 methadone should be weaned to q12 inpatient)
11) Extensive education regarding breast feeding (and the cessation of breastfeeding)
with the mother