Neonatal Abstinence Syndrome

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Neonatal Abstinence Syndrome. Karen Estrella-Ramadan 06/25/2012. Acute use of heroin and other opioids stimulate opiate receptors in the brain which may result in symptoms including euphoria, resp depression, analgesia and nausea. - PowerPoint PPT Presentation

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  • Neonatal Abstinence SyndromeKaren Estrella-Ramadan06/25/2012

  • Acute use of heroin and other opioids stimulate opiate receptors in the brain which may result in symptoms including euphoria, resp depression, analgesia and nausea.Chronic use of opioids s associated with tolerance, which later leads to dependence, whereby the neurochemical balance in the CNS is altered and absence of the drugs leads to withdrawal syndrome

  • Opioids and pregnancyRepetitive use and withdrawal leads to ftal hypoxia, fetal demise, IUGR, SGAMedication-assisted tx with methadoneLong half lifeWith advance pregnancy is metabolized faster and higher doses are required

  • Neonatal Abstinence SyndromeTimingHeroin: 48-72hrsMethadone: 4 daysScreening:Newborn urine:24-48hrsAmphetamines, barbiturates, benzos, cocaine, marijuana, some opioids-my not include methadone or oxycodoneMeconium toxicologyFirst 3-4 daysAmpehtamines, opiods, cocaine, marijuana

  • Clinical FeaturesNEUROLOGICAL:TremorsIrritabilityIncreased wakefulnessHigh-pitched cryingIncreased muscle toneHyperactive deep tendon reflexesExaggerated Moro reflexSeizuresFrequent yawning and sneezingGI DYSFUNCTION:Poor feedingUncoordinated and constant suckingVomitingDiarrheaDehydrationPoor weight gainAUTONOMIC SIGNS: Increased sweatingNasal stuffinessFeverMottlingTemperature instability

  • Treatment~50-70% of infants will require txAt delivery, NO naloxone= seizuresSCORING (modified Finnegan)Before feeding

  • 1. SupportiveEncourage maternal and paternal involvementDecrease stimulation: no light, no loud sounds, examinationSwaddling, soothing, rocking (vertical)Non-nutritive sucking: PacifierSkin-skin contact: Kangaroo careSkin care: lotion to areas of abrassionFrequent feedings: increase caloric intake (150-250 cal/kg/day)May allow BF if neg Utox in mother, HIV neg

  • 2. PharmacologicalScoring >9 (x3: before and after feeding) or 2 >than 12Short acting opioid: MORPHINE (0.4 mg/ml)Start with 0.03 mg/kg/day0.2 mg po q4hrsScoring: q8-12hrsIf still high: increase by 0.16mg/kg/day q3hrs (max 0.8mg/kg/day)Monitor: Over-sedation, decreased arousal, resp depressionWean after 48hrs on scores
  • DischargeOff morphine for 24hrs with score
  • Other things to considerScreens for:SyphilisHepatitis BHepatitis CHIVTbDV

  • Differential dxSepsisHypoglycemiaHypocalcemiahypomagnesemiaHyperthyroidismPerinatal asphyxiaIVH

  • Referenceshttp://www.uvm.edu/medicine/vchip/documents/VCHIP_5NEONATAL_GUIDELINES.pdf (University of Vermont)http://nctnc.org/workfiles/NAS.pdf (University of Connecticut)NICU-SBHhttp://pediatrics.aappublications.org/content/101/6/1079.full