Suggestions for Discharge of an Infant with Neonatal Abstinence Syndrome from a non-Children’s
health care facility
During the Hospitalization
 Full social work evaluation to include family/social history, family/community supports
available to family, risks of illicit drug/substance use by care providers, potential risks for
noncompliance with infant care
 If a primary MD has previously been identified by the family, it is the responsibility of the
neonatologist to communicate with the PMD about their interest/capability of managing an
infant on methadone as an outpatient (this discussion should include a query about the
availability of dispensing methadone in their clinic, the availability of social workers as
needed and ability to respond to home care nurses 24 hours/day)
 Obtain a release of information from the parent/clinical decision maker to allow
information about the infant to be sent to home care, PMD or pediatrician and
pain/palliative care provider
Discharge criteria
 Infant should be on a stable dose of opioid (or other medication) for a minimum of 48 hours
before discharge. Ideal frequency of medication administration is every 12 hours to
maximize medication administration compliance.
 Infants should have Finnegan neonatal abstinence scores less than 8 for 48 hrs prior to
discharge
Referral to Children’s Clinics of Minnesota, St. Paul
 If follow-up will be done at Children’s Clinics of St. Paul, the Children’s pediatrician and
pain/palliative care provider and home care staff will collaborate to evaluate the child. The
first clinic visit must be scheduled within 3 days after discharge.
 When discharge is pending, schedule a Children’s pediatric clinic visit to be within 3 days
after discharge by calling Sandy Kowski at 651 220-6737. A pain/palliative care provider will
also see the infant at this first visit. Sandy will notify the pain/palliative care provider.
Setting up a home care referral to Children’s Hospitals and Clinics of Minnesota
 A home care referral must be made. The infant must be seen by the home care nurse within 13 days after discharge. If the pediatrician will be seeing the patient on day 3, ideally the home
care nurse should meet the infant within 1-2 days after discharge.
Children’s – St. Paul
345 North Smith Avenue
St. Paul, MN 55102
P 651-220-6000
childrensMN.org
Minneapolis, Hospital and specialty clinics
St. Paul, Hospital and specialty clinics
Woodbury, Specialty and rehabilitation clinics
Maple Grove, Rehabilitation clinic
Roseville, Rehabilitation clinic
Minnetonka, Outpatient surgery,
diagnostic center and rehabilitation clinics
Title continued …
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 Contact the home care intake coordinator at 612 813 7519 to notify them of a pending
discharge
 Fax to home care: Fax number 612 813 6358
1) a copy of a physician order for twice weekly home care visits. This order must be signed by a
physician. The order should also state purpose of visits is evaluation of growth and
development, evaluation of neonatal abstinence symptoms, and medication counts.
2) a copy of the inpatient face sheet which includes insurance information and contact
information for the parent or foster parent.
Discharge
 Infants should be discharged with a prescription for individually filled syringes of
methadone, not a bottle. The quantity of methadone scheduled doses should only be
enough medication until the first clinic visit. The infant should also have a prescription for 3
doses of prn methadone for the emergence of withdrawal symptoms. This dose should be
the equivalent of 10% of the total daily dose. (For example, if the child is receiving 0.2 mg
methadone every 12 hours, the infant should be discharged with 3 methadone doses of
0.04 mg prn once per day (in individual syringes).
 The discharge summary should include the following information:
1) known history of maternal drug use including prescribed or illicit drug use
2) maternal toxicology results, infant toxicology results
3) history of inpatient medication taper
4) summary of infant’s withdrawal symptoms and neonatal abstinence scores for the 48
hours prior to discharge
5) current dose of methadone and prescription sent (include quantity information)
 Fax the face sheet, discharge summary and social work evaluation to:
o Home care FAX 612 813 6358
o Pediatrician FAX (attention Sandy Kowski) 651 220 6807
12/26/12