overcome the effects of the substance use and reliably acts to provide necessary care Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 12 Whether the parent has taken steps to change or control the behavior or conditions that placed the child in impending danger, and whether these steps are sufficient to determine the child is safe from impending danger Whether the parent is involved with extended family members, community support networks, or service providers who will help the family maintain these changes over time Whether the parent understands the infant care plan and knows how and where to access help if additional needs for health care or substance abuse treatment arise in the future ARKANSAS Current Through August 2019 Definitions Citation: Ann. Code § 12-18-103; Code of Rules 016 15 CARR 011 The term 'neglect' includes either of the following: Causing a child to be born with an illegal substance present in the child's bodily fluids or bodily substances as a result of the pregnant mother's knowingly using an illegal substance before the birth of the child At the time of the birth of a child, the presence of an illegal substance in the mother's bodily fluids or bodily substances as a result of the pregnant mother's knowingly using an illegal substance before the birth of the child The term 'illegal substance' means a drug that is prohibited to be used or possessed without a prescription under the Arkansas Criminal Code, § 5-1-101, et seq. A test of the child's bodily fluids or bodily substances may be used as evidence to establish neglect. A test of the mother's bodily fluids or bodily substances may be used as evidence to establish neglect. In regulation: Fetal alcohol syndrome disorder (FASD) is an umbrella term used to describe the range of effects or disorders that can occur in an individual whose mother consumed alcohol during pregnancy. Notification/Reporting Requirements Citation: Ann. Code § 12-18-310; Code of Rules 016 15 CARR 011 All health-care providers involved in the delivery or care of infants shall do the following: Contact the Department of Human Services regarding an infant born with and affected by any of the following: – FASD – Maternal substance abuse resulting in prenatal drug exposure to an illegal or a legal substance – Withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance Share all pertinent information, including health information, with the department regarding an infant born with and affected by any of the following: – FASD – Maternal substance abuse resulting in prenatal drug exposure to an illegal or a legal substance – Withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance The department shall accept referrals, calls, and other communications from health-care providers involved in the delivery or care of infants born with and affected by FASD, maternal substance abuse resulting in prenatal drug exposure to an illegal or a legal substance, or withdrawal symptoms resulting from prenatal drug exposure to an illegal or a legal substance. Introduction Neonatal abstinence syndrome (NAS) is a syndrome of substance withdrawal with non-specific signs in the baby following chronic in-utero exposure to a variety of substances including opioids, benzodiazepines, barbiturates, selective serotonin reuptake inhibitors (SSRI), serotonin noradrenaline reuptake inhibitors (SNRI), tricyclic antidepressants (TCA) alcohol and nicotine. 1 NAS is more common in neonates born to opioid dependent women.2 As polysubstance exposure during pregnancy becomes more prevalent3, NAS is becoming an increasingly complex syndrome with less predictable time of onset, severity and response to pharmacologic therapy. 2 Maternal substance use that leads to transient withdrawal or toxicity in the neonatal period may have long term neurodevelopmental effects for the baby.4-6 Signs of withdrawal and/or the ability to adapt ex-utero, depend on the type of substance and the type of neurotransmitter that is affected.7 Signs of NAS may also be due to withdrawal, toxicity or a combination of both.8 In cases of residual toxicity (in contrast to withdrawal), further exposure to the withdrawn substance may have detrimental effects.8 Ideally, engagement with women and their families about NAS begins in the antenatal period. Refer to Queensland Clinical Guideline: Perinatal substance use: maternal9 1.1 Incidence in Queensland Reporting and comparison of NAS is complicated by different definitions, screening, assessment and diagnostic tools used in different countries, and the variety and subtlety of clinical presentation.10,11 At the time of publication, no Queensland Health data was approved for inclusion. 1.2 Modulating factors Factors that influence the likelihood of developing NAS, timing of onset, presentation and severity of signs are not completely understood and vary significantly among babies exposed to substances inutero. 7,12 Table 1. Modulating factors for NAS Aspect Consideration Gestational age and gender • Preterm babies have less severe NAS related to13: o Developmental immaturity of specific opiate receptors and neurotransmitter function o Reduced time exposed to opioids in-utero o Reduced fatty deposits of substances • Risk