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Neonatal Abstinence Syndrome

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Zain Velji

on 10 August 2017

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Transcript of Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome
Table of Contents
1. What is it?
2. How does it happen?
3. Assessment
4. What do you do about it?
5. Sending baby home
6. Nursing implications

How Does it Happen?
Assessment
Non-Pharmacological Treatment
Assessment
Encourage parent/care provider involvement
Minimize excessive handling
Don't wake a sleeping baby
Low stimulation
Soothing measures
Skin care
Feeding

(AHS, 2016; Dow et al., 2012; Velez & Jansson, 2008)

Embryonic Period:
• Significant teratogenic effects
Fetal Period:
• Abnormal growth &/or maturation
• Alterations in neurotransmitters & their receptors
Impact After Birth
• Withdrawal symptoms

(Behnke & Smith, 2013)
Exposure to:
Opioids (cocaine, heroin, Demerol, morphine, methadone, oxycodone)
SSRIs
Benzodiazepine
Nicotine
Comprehensive history
Urine sample up to 24h of age (minimum of 5mL)
Negative result doesn't mean no drugs!
Withdrawal symptoms start within 48 - 72h
Modified Neonatal Abstinence Score


(AHS, 2016)
Neonatal Abstinence Syndrome (NAS)
Signs and symptoms exhibited by a newborn experiencing opioid withdrawal:
High-pitched cry
Dehydration
Diarrhea
Diaphoresis
Hyperreflexia
Fever
Congestion
Irritability
Sleeping difficulties
Seizures

(Kellogg et al., 2013)
Pharmacological Treatment
Discharge Planning
Nursing Implications
When non-pharmacological supportive measures fail:
Morphine
Methadone
Clonidine
Phenobarbital
Cardio-respiratory monitoring
Refer to AHS policy for dosing & weaning guidelines


(AHS, 2016; Dow et al., 2012)
Assess social risk & safety issues
Discharging an infant on morphine:
Weekly follow-up with designated healthcare provider
Weaning schedule
Care provider competence in administering medications
Education
Refer to AHS policy

References
(AHS, 2016)
(AHS, 2016)
(1:49-2:12; High-pitched cry)



http://www.innerrealmscenter.com/wp-content/uploads/2016/07/opioids-compressed.jpgfsd
Self reporting
Biological Specimens:
o Urine
o Meconium
o Hair
Alberta Health Services. (2016). Neonatal abstinence syndrome for antenatally exposed infants (Document # 2-N-5). Retrieved from https://myahs.ca/insite/assets/policy/clp-calgary-childrens-health-neonatology-neonatal-abstinence-syndrome-antenatally-exposed-infants-2-n-5.pdf

Behnke, M., & Smith, V. C. (2013). Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus. American Academy of Pediatrics,131(3), 1009-1024. doi:10.1542/peds.2012-3931

​Dow, K., Ordean, A., Murphy-Oikonen, J., Pereira, J., Koren, G., Roukema, H., ... & Turner, R. (2012). Neonatal abstinence syndrome clinical practice guidelines for Ontario. Journal of Population Therapeutics and Clinical Pharmacology, 19(3), e488-506.

Kellogg, A., Rose, C. H., Harms, R. H., & Watson, W. J. (2011).
Current trends in narcotic use in pregnancy and neonatal outcomes. American journal of obstetrics and gynecology,
204(3), 259-e1.

Kocherlakota, P. (2014). Neonatal abstinence syndrome. Pediatrics, 134(2), e547-e561.

Velez, M., & Jansson, L. M. (2008). The Opioid dependent mother and newborn dyad: non-pharmacologic care. Journal of Addiction Medicine, 2(3), 113–120. doi: 10.1097/ADM.0b013e31817e6105
https://i.ytimg.com/vi/GDSYH-0fU0w/maxresdefault.jpgsdfu

https://etimg.etb2bimg.com/photo/52265038.cms
http://www.mercydesmoines.org/childrenshospital/variety-nicu
http://vishwarajhospital.com/pediatrics-neonatology/
(AHS, 2016)
Congestion; Jitters
Tremors (severe)
Impact on Fetus
How to Detect it:
What do YOU think?
Full transcript