In Kentucky, healthcare providers test both the mother and her newborn baby if they suspect the mother was using drugs while she was pregnant.
- When a pregnant mother ingests drugs, the substance passes through the womb to the baby, causing the newborn to become dependent along with the mother.
- Once the child is delivered, they are longer receiving drugs from the mother and start to experience withdrawal that require immediate treatment.
This condition, known as Neonatal Abstinence Syndrome or NAS, has gained national attention because the opioid crisis has caused a surge in babies born with NAS complications.
Although new mothers cannot be prosecuted criminally for using drugs while pregnant, Kentucky considers it child abuse if any baby is born withdrawing from drugs that the mother took while pregnant.
What is required for a hospital to order a drug test for a newborn?
Most hospitals do not test every new mother and her child for drugs. Typically, drug tests are only ordered if drug use is suspected or if the baby develops withdrawal-like symptoms after birth.
The ANGELS Neonatal Guidelines, followed by most medical providers, recommends a drug test be conducted if any of the following are true:
- History of maternal drug use or agitated/altered mental status in the mother
- No prenatal care
- Unexplained separation of the uterus and placenta before childbirth (placental abruption)
- Unexplained complications in the newborn’s central nervous system (e.g. seizures, brain hemorrhages)
- Symptoms of drug withdrawal in the newborn (abnormally rapid breathing, tightened muscles, excessive stooling)
- Changes in the behavioral state of the newborn (jittery, fussy, lethargic)
How are drug tests conducted on newborns in 2021?
As of 2021, most hospitals in Kentucky use risk-based testing. This means doctors only order a drug test on the baby when they suspect the mother is using drugs.
Universal testing, where a hospital drug tests every new baby that is born, is much less common but becoming more popular since the opioid epidemic increased the number of babies born addicted.
If doctors suspect that a newborn baby has NAS, they will send the baby’s meconium (stool) or urine to a lab to determine what type of substances are present in their system. A simple urine test is usually also given to the mother.
If the results of either test are positive, the doctor is required to report it to the Kentucky Department of Community Based Services.
What happens if a baby tests positive for drugs in their system?
If a baby tests positive for drugs in Kentucky (and most other states), doctors will keep them in the hospital for about four to seven days to treat withdrawal symptoms and make the child as comfortable as possible.
Once doctors confirm that the baby has NAS, they begin the process of reporting it to Child Protective Services:
- The baby is evaluated and treated for about 4-7 days. NAS is noted in the child’s medical charts
- Doctors usually report the case to the Kentucky Department of Community Based Services (only about 85% of NAS cases are reported)
- Kentucky DCBS usually opens a child abuse investigation (only about 76% of reported cases are investigated)
- A caseworker follows up with mother and child to determine if the child is being neglected
- If neglect is confirmed, the case goes to family court
- Family court determines if the baby should be removed from the care of the mother
Typically, mothers that give birth to a child with NAS are given two options – get professional addiction treatment within 90 days of the baby’s birth or have their parental rights taken away. (Kentucky Medicaid covers rehab).
While this may seem harsh, the goal of these laws is not to punish mothers for doing drugs, but to keep the child safe.
What is Neonatal Abstinence Syndrome (NAS)?
NAS is a group of conditions caused when a baby withdraws from drugs due to exposure in the womb. The symptoms are similar to adult withdrawal symptoms, but with serious potential for lifelong issues.
Babies who are born with NAS require extra care and attention, and many stay in the hospital for a few days to a week to monitor their symptoms and progress. Doctors administer a morphine taper to gently lower their tolerance without sending them into full withdrawals.
What are the symptoms of Neonatal Abstinence Syndrome?
Babies with Neonatal Abstinence Syndrome start showing symptoms within the first few days of their birth. Symptoms can include, but are not limited to:
- Tight muscle tone (hypertonicity)
- Abnormally rapid breathing (tachypnea)
- Problems sleeping
- Excessive yawning
- Poor feeding or sucking
- Stuffy nose
The term NAS usually refers to opiates, but most drugs can pass from a pregnant mother to her baby. The symptoms that a newborn with NAS experiences vary depending on the type of drug that the mother was abusing and their gestational age at birth.
What are the long-term consequences of Neonatal Abstinence Syndrome (NAS)?
Some babies go on to live full, healthy lives free of health complications despite having NAS at birth. Many other babies experience chronic issues associated with this condition, such as:
- Increased risk for sudden infant death syndrome (SIDS)
- Developmental delays
- Motor problems related to the bones and muscles and the function of them
- Behavioral problems
- Learning problems
- Complications with vision
- Regular ear infections
- Problems sleeping
It is often misconstrued just how serious neonatal abstinence syndrome is both in the moment and over time.
What if I’m pregnant and I need help with addiction?
Get help! You and your baby are better off in treatment – even if you already used drugs while pregnant. Detoxing cold turkey puts you and your baby at risk. Suboxone can be an option even while pregnant.
JourneyPure has a Bowling Green Rehab that serves those addicted to alcohol or drugs across Kentucky. The center is medically equipped and regionally recognized for treating pregnant women.
Additionally, there are outpatient options throughout Kentucky:
JourneyPure.com doctors follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, count records, academic organizations, highly regarded nonprofit organizations, government reports and their own expertise with decades in the fields and their own personal recovery.
(2021). Kentucky Revised Statutes. Kentucky General Assembly; Kentucky Legislative Research Commission. https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=50037
(2020, September). Neonatal Abstinence Syndrome Reporting Registry – Annual Report 2019. Kentucky Cabinet for Health and Family Services; Kentucky Department for Public Health. https://chfs.ky.gov/agencies/dph/dmch/Documents/NASReport.pdf
Farst, K. (2009, September 3). Newborns Exposed to Illicit Drugs In-Utero. University of Arkansas for Medical Sciences. https://angelsguidelines.com/guidelines/newborns-exposed-to-illicit-drugs-in-utero-discussion-of-garretts-law/
(2016, January). KY Neonatal Abstinence Reportable Disease Guidance. Kentucky Cabinet for Health and Family Services. https://chfs.ky.gov/agencies/dph/dmch/Documents/NASHospitalReportingGuidanceDocumentupdated1616.pdf
(2019, June). NEONATAL ABSTINENCE SYNDROME (NAS). March of Dimes. https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx
(2019, June). PREVENTING NAS IN YOUR BABY INFOGRAPHIC. March of Dimes. https://www.marchofdimes.org/pregnancy/preventing-nas-in-your-baby-infographic.aspx
Neonatal Abstinence Syndrome. Stanford Children’s Health. Retrieved 7/29/21, from https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387
Neonatal Abstinence Syndrome (NAS). North Carolina Pregnancy & Opioid Exposure Project. Retrieved 7/29/21, from https://ncpoep.org/guidance-document/neonatal-abstinence-syndrome-overview/neonatal-abstinence-syndrome-nas/
Jansson, L. M., Velez, M., & Harrow, C. (2009). The opioid-exposed newborn: assessment and pharmacologic management. Journal of opioid management, 5(1), 47–55.
Syme, M. R., Paxton, J. W., & Keelan, J. A. (2004). Drug transfer and metabolism by the human placenta. Clinical pharmacokinetics, 43(8), 487–514. https://doi.org/10.2165/00003088-200443080-00001
Logan, B. A., Brown, M. S., & Hayes, M. J. (2013). Neonatal abstinence syndrome: treatment and pediatric outcomes. Clinical obstetrics and gynecology, 56(1), 186–192. https://doi.org/10.1097/GRF.0b013e31827feea4
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