Mom had one prenatal visit (total) at 38 weeks, in which she was prescribed tylenol 3. She had a prior script for Norco (from another Dr.) but was told not to take both. Well, baby is in withdrawal. We are a level II/well baby and our docs are mostly family medicine and don't get much exposure to these poor kiddos. There were no orders given on this baby except routine care. This baby shows lots of signs of withdrawal. From mild-moderate tremors, temp 100.1, high pitched cry (didn't sleep the entire first day for more that 5 minutes), sneezing, vomitting constantly, weight loss >10% on day one, etc. So, I started NAS scores.. At 26 hours of age the first score was 19! The nurse in charge of his care didn't want to wake the docs (who were aware of possible withdrawal). The Dr. pulled a pharmacy report and it was 3 pages long! ER's from all over town, pharmacies too. Mostly tylenol 3 and Norco. This is since the beginning of pregnancy. So, last night I asked the Dr. about the POC. I suggested considering morphine and he was floored! He said he would only go that route if the baby started seizing. I did more research and gave him a copy and he gladly read it. He's a resident, so I understand he is still learning (as am I). He called his attending and they decided to still refrain from interventions.
What would be the standard of care in this situation? Am I off base with the morphine? I have some NICU experience, but not enough withdrawal experience to back this up with just my brain cells. But I do know when I worked the NICU, that when babies were in withdrawal they had NAS scores ordered and morphine (for opiates) to get them through it (titrated with the scores).
Thanks for anything you can throw my way.