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If not, transfer to unit/facility that can provide appropriate monitoring See Appendix 4: NCNC ESC Algorithm Methadone for flowchart of treatment progression Starting methadone: PRN Phase Consider starting PRN Neonatal Methadone 1mg/ml oral solution 0.07mg/kg/dose q8 hours PRN after a team huddle if infant is unable to E-S-C despite optimizing non-pharmacologic care Team huddle consists of bedside nurse, MD, and infants primary caregiver Four additional doses may be given q8 hours PRN for continued failure to E-S-C due to NOWS despite optimal non-pharm care

Did such a thing even remotely happen