Neonatal Abstinence Syndrome (NAS)
• NAS may present in a baby who is exposed to medication taken by the mother prior to birth
Withdrawal• NAS is the signs and symptoms of
withdrawal after birth.
• It can be severe if not accurately assessed and treated.
• Methadone and Subutex withdrawal may not be seen until 3-7 days after birth.
• The length of stay for the baby may vary from 10 days to several months.
Finnegan Scoring System
• A tool used to assess withdrawal symptoms in the baby.
• Based on the baby’s scores decisions will be made as to if or when the medication will start.
• Receiving medication is called replacement therapy.
• Morphine
• Methadone
Finnegan Scoring System
• The dose and medication used will depend on Finnegan Scores, weight, and the type of medication used during pregnancy.
• Medications are adjusted or weaned based on withdrawal signs.
• Every baby responds differently to the weaning process.
• Sometimes medication is stopped and may need to be restarted due to withdrawal signs.
Finnegan Scoring System(refer to actual tool)
• Contains 21 symptoms of withdrawal divided into 3 categories:
1.Central Nervous System Disturbances
2. Gastrointestinal Disturbances
3. Respiratory and Vasomotor Disturbances
Finnegan Scoring System
• Assessment is not of a single point in time, scores should reflect all the symptoms observed since the last scoring time.
• Observation by the healthcare worker and parents for symptoms is very important.
• The baby will be scored every 3 hours before feedings.
CNS Disturbances
• Excessive or high pitched cry
• Sleeplessness
• Excoriation
• skin breakdown on chin, knees, elbows, toes, or nose
• Jerks or tremors, jitteriness, irritability
CNS Supportive Measures
• Soothe baby with swaddling
• Talk/hum quietly
• Hold baby close to body
• Use infant swing/vibrating chair
• Reduce noise and lighting in room
• Skin to skin holding (kangaroo care)
• Use protective skin creams
• Handle baby with slow gentle movements
• Use infant massage or swaddle bath
Gastrointestinal Disturbances
• Excessive sucking- does not always mean they are hungry
• Poor feeding
• Vomiting
• Skin breakdown due to loose stool/diarrhea
• Gas pain
Gastrointestinal Supportive Measures
• Use pacifier/sweet ease
• Feed on 3 hour schedule (reduce noise during feeding)
• Use breast milk (may reduce the severity of the symptoms)
• Burp regularly
• Do not overfeed
• Change diaper often
Respiratory/VasomotorDisturbances
• Sweating
• Fever (temp >99)
• Nasal stuffiness/excessive nasal secretions
• Nasal flaring/fast breathing
• (> 60 bum)
• Yawning
• Sneezing
• Mottled color
Respiratory/Vasomotor Supportive Measures
• Do not overdress or over swaddle baby
• Use infant sleep sac
• Use gentle suction if nasal secretions cause blockage
Respiratory/VasomotorSupportive Measures
Safe Sleep• Back to Sleep
• Best position is on back, in sleep sac, in crib
• Infant swings/vibrating chairs may be utilized at intervals while parent is awake.
• Infant should never be left unattended on couch or chair.
• Infant should never sleep on couch or in chair with parent.
Thank You!• Parent presence is very important for early
response to withdrawal signs and calming the baby.
• We realize this is very tiring. We suggest parents take turns with care/feeding activities to allow themselves to rest. Also, break periods outside may help you refresh.
• Do not hesitate to ask for help from the staff. We are a team working together for the common goal of getting your baby home as quickly and safely as possible!
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