Neonatal Abstinence Syndrome:

What is it?

Neonatal abstinence syndrome is a withdrawal response that occurs in newborns. Infants are withdrawing from maternal addictive substances they were exposed to in utero. NAS has both medical and developmental consequences for the newborn.

Pathophysiology? How?Drugs are transferred from the mother to the fetus via the placenta. During birth the passage of drug is discontinued which causes the neonates CNS to become over stimulated and thus causing the symptoms of withdrawal.

Symptoms?NAS occurs in 55-94% of neonates that were exposed to opiates in utero. The presentation of symptoms and the length of withdrawal are dependent upon the amount and type of drug that was used in pregnancy, duration of addiction and time of last maternal dose prior to delivery. Symptoms begin anywhere from 48 hours to 72 hours after birth. NAS can last from one week to six months

Withdrawal Symptoms: Central Nervous System

Tremors Irritability High-pitched cry Abnormal or excessive

suck Seizures

Autonomic System Sneezing Yawning

Gastrointestinal Symptoms Diarrhea Loose/Watery Stools Vomiting

Pulmonary Symptoms Tachypnea Respiratory Distress

NASS:When a neonate is suspected to be experiencing withdrawal, there are several tools used to assess the newborn. For example A neonatal abstinence scoring system is used to determine the severity.

Treatments

Pharm: Newborns with symptoms of diarrhea, vomiting, seizures and excessive

weightloss, insomnia or fever will require drug therapy. Common medications prescribed to decrease the babys symptoms of NAS

include morphine, paregoric, phenobarbital, methadone, clonidine, chlorpromazine and diazepam.

Oral morphine is most commonly used in Canada for newborn withdrawal.

Nonpharm: Comfort:

o Infant comfort measures are import than minimize physiologic effects of withdrawal caused by the central and autonomic system.

o Keep a quiet dark environment. Tight swaddling is used to decrease irritability behaviours, gentle rocking, pacifiers are useful to help infants soothe themselves, (Non-nutritive sucking helps to decrease the stress in the infant and have less erratic, uncoordinated movements.)

o Providing comfort also improves feeding which can lead to weight gain, and promotes mother-newborn interactions.

Nutrition o Since neonates with NAS have impaired feeding habits it may be

difficult for the infant to gain weight therefore high calorie formulas used to facilitate weight gain.

o Small, frequent meals encouraged because NAS have frequent gi upsets and this will improve digestion

o Breastfeeding is encouraged unless the mother is still using drugs.

Barriers to seeking/preventing treatment:

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ReferencesLall, A. (2008). Neonatal abstinence syndrome. British Journal of Midwifery,16(4), 220-223.

Nelson, M. M. (2013). Neonatal Abstinence. Childbirth Education, 28(1), 38.

Bass III, P. F. (2015). Neonatal abstinence syndrome.

Ashraf, H. (2014, August 11). Neonatal Abstinence Syndrome Treatment & Managemen. Retrieved from http://emedicine.medscape.com/article/978763-treatment

Chow, J., Scott, S., Kyle, T., Ateah, C., & Ricci, S. (2013). Nursing management of the newborn at risk: Acquired and congenital newborn conditions. In Canadian Maternity and Pediatric Nursing (pp. 779-783). Philadelphia, PA: Wolters Kluwer Health.

Preventing fasd and fas. (2013, May 2). Retrieved from http://fasd.alberta.ca/

 It's safe for a pregnant woman to take tranquilizers, sleeping pills, or amphetamines.?The correct answer is B. False .Babies born to mothers who take these medications can have trouble breathing, poor muscle tone, and other developmental problems.

Aspirin and ibuprofen are safe to take while pregnant? No they are not.Over-the-counter (OTC) medicines, such as aspirin, ibuprofen, laxatives, or cold or allergy medicines, may be harmful to an unborn child. Always talk with your obstetrician (pregnancy doctor) before taking OTC medications or medicines prescribed by a different doctor.

What can we do? Encourage nonopiod pharmacologic management of pain in pregnany

women such as physical therapy, and massage therapy. Educate the mother about NAS and plan for the babys needs Connect the mother we community resources.

Why do women use substances during pregnancy? There are several different reasons. In the early stages of pregnancy the woman may not be aware that she is pregnant, she may not be aware of the effects of drunking, smoking and other drugs have on the fetus, or maybe given inaccurate information . Threfore she may continue to use, some may not be able to stop even if they want to.

Want to quit or cut down their use when they discover they are pregnant. However, these women face many barriers in seeking treatment for their substance use.

Barriers to Seeking & Receiving treatment?

Stigma, guilt- Women do not seek treatment because they are aware of the stigma that is attached to mothers who use substances. They feel guilty or ashamed and this stigma prevents them from seeking help from health professionals and social services. There may

also be stigma from professionals providing care as they may have negative attitudes towards women who use drugs while pregnant. Fearful of loosing custody of the child fearful of disclosing that they have a substance use problem and seeking treatment.

Social Support – is there resistance from the people in her life? are their friends and family supportive of her efforts to change.

Access and availability- many factors that come to play does she have physical access to treatment services? Does she have transportation, financial issues? Unemployed? Lowincome? Distance of outpatient programmes?