Maternal use of certain drugs during pregnancy can result in transient neonatal signs consistent with withdrawal or acute toxicity or cause sustained signs consistent with a lasting drug effect. In addition, hospitalized infants who are treated with opioids or benzodiazepines to provide analgesia or sedation may be at risk for manifesting signs of withdrawal. This statement updates information about the clinical presentation of infants exposed to intrauterine drugs and the therapeutic options for treatment of withdrawal and is expanded to include evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.

Provision of risk-appropriate care for newborn infants and mothers was first proposed in 1976. This updated policy statement provides a review of data supporting evidence for a tiered provision of care and reaffirms the need for uniform, nationally applicable definitions and consistent standards of service for public health to improve neonatal outcomes. Facilities that provide hospital care for newborn infants should be classified on the basis of functional capabilities, and these facilities should be organized within a regionalized system of perinatal care. Pediatrics 2012;130:587-597 OBJECTIVE This revised policy statement reviews the current status of the designation of levels of newborn care definitions in the United States, which were delineated in a 2004 policy statement by the American Academy of Pediatrics (AAP). 1 Since publication of the 2004 policy statement, new data, both nationally and internationally, have reinforced the importance of well-defined regionalized systems of perinatal care, population-based assessment of outcomes, and appropriate epidemiologic methods to adjust for risk. This revised statement updates the designations to provide (1) a basis for comparison of health outcomes, resource use, and health care costs, (2) standardized nomenclature for public health, (3) uniform definitions for pediatricians and other health care professionals providing neonatal care, and (4) a foundation for consistent standards of service by institutions; state health departments; and state, regional, and national organizations focused on the improvement of perinatal care.

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