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
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
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
