Neonatal Abstinence Syndrome: A Family Centered Approach to Care
Kelly Outlaw, M.S., CCLS
Objectives1 - Attendees will learn what Neonatal Abstinence Syndrome is2 - Attendees will identify the unique psychosocial needs of the infant and mother/caregiver3 - Attendees will understand the challenges of working with this population4 - Attendees will learn techniques to support the NAS infant in the NICU5 - Attendees will identify opportunities to empower and promote infant and mother/caregiver bonding
Neonatal Abstinence Syndrome (NAS)As caregivers, our responsibility lies in doing all we can, to identify drug affected infants and to ensure that they are provided the care and protection each one deserves.
What is Neonatal Abstinence Syndrome (NAS)?Neonatal Abstinence Syndrome (NAS) is a group of problems that occur in a newborn who was exposed to additive illegal or prescription drugs while in the mothers womb. These and other drugs pass through the placenta the organ that connects the baby to its mother in the womb and reach the baby. The baby becomes addicted along with the mother.
Neonatal Withdrawal SymptomsCNSDisturbed sleep patterns, hyperactivity, tremors, increased muscle tone, myoclonic jerks, shrill cry, convulsions
Metabolic fever, hypoglycemia, mottling, sweating, yawning, vasomotor instability
RespiratoryNasal flaring, sneezing, tachypnea, hiccups
GastrointestinalExcessive sucking, poor feeding, vomiting, diarrhea
Common Drugs Found in NAS BabiesOpiatesMethadone, Oxycodone, OxyCotin, Vicodin, HeroinePsychotropicAntidepressantsStimulantsAmphetaminesDepressants, Sedative-hypnoticsBarbiturates, Quaaludes, Tranquilizers
Half Life and Symptom PresentationOpiatesshorter half-lives, symptoms may present within 72 hours of birth
Depressants, Sedative-hypnoticslonger half-lives, symptoms may present 2-4 weeks after birth
Signs and Tests to Diagnose NAS
Finnegan score which assigns points based on each symptom and its severity. The infants score can help determine treatment
Toxicology of first bowel movement (meconium)
Urine test (urinalysis)
Reporting Substance Exposed Newborns to CPSFederal law now requires under the Keeping Children and Families Safe Act of 2003 that all health care providers refer all infants identified as drug exposed to Child Protective Services. At this time fewer than half of the states have laws requiring reporting. This means that many states may not have laws requiring these infants to be reported.
Medical ManagementBabies stay in the NICU anywhere from several days to several months
Babies may receive a combination of oral Morphine, Phenobarbital, Methadone, or Seizure medication
Some babies who have very poor feeding may get an NG tube
Non Pharmalogical ManagementTherapeutic Handling
Controlling the Babies External Environment
Teaching the Parent/Caregiver Handling and Bonding techniques
Interventions the Child Life Specialist Can use in the NICUEnvironmental Support
Education on Infant Development
Education on Shaken Baby Syndrome
Car Seat Safety
Other Services Offered
Prenatal Education Classes
Education to Hospital StaffPediatric unit, NICU, ER
Community Education NOPE (Narcotic Overdose Prevention and Education)Education to Pediatricians on NAS symptomsEducation to Obstetricians
Challenges Faced by Healthcare Team Working With NAS Infants and Their Families
ReferencesBandstra, E. S., Morrow, C. E., Mansoor, E., & Accornero, V.H. (2010). Prenatal drug exposure: infant and toddler outcomes. Journal of Addicitve Diseases, 29, 245- 258.
Beachy, J.M. (2003). Premature infant massage in the NICU. Neonatal Network Journal, 22(3), 39-45.
Hernandez-Reif, M., Diego, M., & Field, T. (2007). Preterm infants show reduced stress behaviors and activity after 5 days of massage therapy. Infant Behavior & Development, 30(4), 557-561.
Karp, H. (2002). The happiest baby on the block. New York, NY: Random House.
McGlade, A., Ware, R., & Crawford, M. (2009). Child protection outcomes for infants of substance-using mothers: a matched-cohort study. Pediatrics, 124(1),285-293.
ReferencesMurphy-Oikonen, J., Brownlee, K., Montelpare, W., & Gerlach, K. (2010). The experience of NICU nurses in caring for infants with neonatal abstinence syndrome. Neonatal Network, 29(5), 307-313.
Rigg, K. K., & Ibanez, G. E. (2010). Motivations for non-medical prescription drug use: a mixed methods analysis. Journal of Substance Abuse Treatment, 39, 236-247.
Valez, M., & Jansson, L. M. (2008). The opioid dependent mother and newborn dyad: non-pharmacologic care. Journal of Addiction Medicine, 3, 113-120, doi:10.1097.
Kelly Outlaw MS, CCLSSt. Josephs Childrens Hospital(813) 554-8509Kelly.email@example.com