Neonatal abstinence syndrome
•Download as PPTX, PDF•
3 likes•1,740 views
This presentation discusses neonatal abstinence syndrome, which occurs when a newborn experiences withdrawal symptoms from exposure to addictive drugs in the womb. The presenter outlines the incidence, types, etiology, symptoms, exams/tests used for diagnosis, and management approaches for NAS. Regarding management, non-pharmacological interventions like swaddling and minimal stimulation are recommended initially. If symptoms are severe, pharmacological therapy using morphine, methadone or clonidine may be used. The roles of nurses in assessing exposed newborns, monitoring withdrawal, and coordinating multidisciplinary care are also reviewed. The presenter emphasizes the importance of prevention through screening, education, and treatment programs for pregnant women with substance use
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Neonatal abstinence syndrome
Similar to Neonatal abstinence syndrome (20)
Recently uploaded
Recently uploaded (20)
Neonatal abstinence syndrome
- 1. A PRESENTATION ON NEONATAL ABSTINANCE SYNDROME BY Mr VINU.K.S ASSISSTANT PROFESSOR PEDIATRIC DEPATMENT NAINCY COLLEGE OF NURSING NAINITAL
- 2. Neonatal abstinence syndrome Neonatal abstinence syndrome (NAS) is a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother’s womb
- 4. Incidence
- 5. Types Two major types of NAS are recognized: prenatal or maternal postnatal
- 6. Etiology Illicit drug intake of pregnant women eg: heroin Exposure of foetus to alcohol, marijuana and so on
- 8. Symptoms The symptoms of neonatal abstinence syndrome depend on: The type of drug the mother used How the body breaks down and clears the drug How much of the drug she was taking How long she used the drug Whether the baby was born full-term or early (premature)
- 9. CNS dysfunction includes the following features: High-pitched cry Restlessness, with sleep duration less than 1-3 hours after feeding Hyperactive reflexes Jitteriness Tremors Hypertonia Myoclonic jerks Generalized convulsions
- 10. Metabolic, vasomotor, and respiratory disturbances include the following features Sweating Fever Mottling Frequent yawning Respiratory rate greater than 60 breaths per minute without retractions Sneezing (>3 times per interval) Apnoea Nasal flaring
- 11. GI dysfunction includes the following features: Excessive (frantic) sucking Poor feeding Hyperphagia, usually associated with poor weight gain Regurgitation or projectile vomiting Loose or watery stools
- 12. Alcohol-specific symptoms include the following: Neonates also exhibit irritability, tremors, seizures, Opisthotonos, and abdominal distention.
- 13. Exams and Tests History collection Physical examination Toxicology (drug) screen of urine and of first bowel movements (meconium). Finnegan scoring system
- 15. NAS Scoring Protocol Initiate scoring within 2 hours of admission Infants should not be awakened to obtain a score Infants at risk of opiate withdrawal are assessed for signs of withdrawal ½ to 1 hour after each feed The scoring chart is designed for term infants. Allowances must be made for infants who are preterm
- 16. Management Treatment depends on : the drug involved The infants overall health and abstinence score Whether the baby was born full-term or premature
- 17. Non-Pharmacologic Interventions NAS TLC ( tender loving care ) Swaddling Rocking Minimal sensory or environmental stimulation Maintain temperature stability High caloric feed Breastfeeding
- 18. Pharmacologic Therapy NAS Dilute Morphine Sulfate Oral solution Methadone maintenance therapy Clonidine
- 19. Pharmacologic therapy NAS Begin when 2-3 consecutive Finnegan scores are ≥8 or when the sum of 3 consecutive Finnegan scores is ≥24 Based upon toxicology and clinical presentation initiate drug therapy
- 20. Pharmacologic therapy NAS Morphine or methadone are first-line opiates Clonidine is a first line or adjunctive therapy used in combo with an opiate for poly-substance exposure
- 21. Role of nurse Assess the women prenatally. Identify the prenatal substance use of women. Identify women’s need. Assessment of baby by using Finnegan scale for withdrawal symptom.
- 22. Role of nurse Assess the maternal well being and parenting skills. Circulate the planned discharge plan to a multidisciplinary care team. Medical and psycho social assessment of mother and baby
- 23. Prevention During Preconception period: Promote awareness of effects of parental substance use. No use of alcohol and opioids when planning and during pregnancy. Discuss all medicines and alcohol and tobacco use with your health care provider
- 24. Prevention During Antenatal period: Screening for pregnant women to identify the substance abuse provide the enhanced the referral services if necessary.
- 25. Prevention At birth: Use consistent and effective protocols for identification of substance exposed newborns Make assurance for developmental child welfare services.
Editor's Notes
- NAS due to prenatal or maternal use of substances that result in withdrawal symptoms in the newborn postnatal NAS secondary to discontinuation of medications such as fentanyl or morphine used for pain therapy in the newborn.
- Myoclonic jerks – sudden muscle contraction
- Apnoea- temporary cessation of breath, specially during sleep. Mottling – blotching of skin Nasal flaring – widening of nostrils while breathing.
- Opisthotonos – backward arching of head, neck and spine due to muscle spasm
- History collection - Many other conditions can produce the same symptoms as neonatal abstinence syndrome. To help make a diagnosis, the health care provider will ask questions about the mother's drug use. The mother may be asked about which drugs she took during pregnancy, and when she last took them. The mother's urine may be screened for drugs as well. Finnegan scoring system Neonatal abstinence syndrome scoring system, which assigns points based on each symptom and its severity. The infant's score can help determine treatment.
- The optimal treatment for NAS has not been established. Primary treatment of neonatal symptoms related to prenatal substance exposure should be supportive because pharmacologic therapy can prolong hospitalization and exposes the infant to additional agents that are often not necessary. However, pharmacotherapy for infants with more severe expression of NAS is necessary to allow them to feed, sleep, gain weight, and interact with caregivers. Opioids are currently considered the first-line therapy. Second-line therapy has been phenobarbital. Phenobarbital has been effective for the treatment of opioid withdrawal seizures and polydrug exposure.
- Clonidine – alpha 2 adrenergic agonist ,which will stimulate the alpha 2 receptors in brain which reduce the peripheral vascular resistance and thus decrease the BP Methadone – its mu opioid antagonist Morphin-pail reliever.
- Should do the medical and psycho social assessment of mother and baby before discharge that indicate a stable condition.