Resilience After Infant Substance Exposure (RISE) Program

Resilience after Infant Substance Exposure (RISE) is a clinical care track within the Neonatal Follow-up Program (NFP) at Children’s Hospital of Philadelphia (CHOP) that provides specialized care for infants who have been exposed to substances, such as opioids, before birth.

What is NOWS?

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).

The physical symptoms of NOWS can be caused by many different types of drugs, including prescription and non-prescription opioids, and they can be similar to some symptoms of substance withdrawal experienced by adults. Symptoms of NOWS usually begin within two to three days after birth, and they can last for months.

Symptoms range from mild to severe and can include:

• Body shakes
• Excessive crying and fussiness
• Fever
• Diarrhea
• Trouble sleeping
• Poor feeding
• Breathing problems

Some babies are able to have their NOWS symptoms soothed through swaddling, rocking or skin-to-skin contact from their parents or nurse. 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 the baby is stopped or weaned off.

Why RISE?

The Resilience after Infant Substance Exposure (RISE) Program brings together expertise across multiple disciplines including 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 parents, caregivers and family members. 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 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.