Patt y Zett erberg, MSN, C-PNPDirector, C l in ica l Operati ons

Medica l Practi ce Management

East Tennessee Chi ldren’s Hospita l

Neonatal Abstinence Syndromeand Long-Term Effects of Intrauterine Drug Exposure

Tolerance – Dependence – Addiction

ToleranceOur body develops tolerance to a drug’s effect so that an increased amount of drug is required to produce effect. DependenceIf the supply of the drug is removed then the person will exhibit “withdrawal symptoms”. AddictionThe continuing, compulsive nature of the drug use despite physical and/or psychological harm to the user and society.

What Problems Does NAS Cause?

AT BIRTH•Increased risk of preterm birth•Low birth weight•CNS (Central Nervous System): irritability•Musculoskeletal: agitation, tremors, increased tone (stiffening)•Respiratory: nasal congestion, increased respiratory rate•GI (Gastrointestinal): emesis (vomiting), reflux, diarrhea

Typical Course of TreatmentMedication

60 % of NAS babies•Morphine only•LOS 20 days

35% of NAS babies•Require adjunctive meds• Phenobarbital (15%)• Clonidine (9%)• Phenobarbital + Clonidine (11%)

•LOS 28 days• Longest LOS = 155 days

5% of NAS babies LOS 31 days

MedicationPositioning, comfort measuresFormula changes for refluxRooming-InHome…follow-up appointments

Typical Course of Treatment

LONG-TERM EFFECTS•Sleep Regulation•Mood/Behavior Regulation•Attention Regulation•Sensory Regulation•Pain Management Regulation

SleepBrain opiate receptors and onset/regulation of sleep

“Quiet sleep” significantly reduced, even 4-5 weeks after NAS treatment finished

Toddler sleep

Behavior RegulationEmotional reactivity

Lack of self-regulationRule-breakingAggression

Increase in oppositional defiant disorder

Attention RegulationDecreased “executive functioning”

Attention: decreased sustained attention, decreased selective attention

Impulse controlAggression

Decreased perceptual reasoning (envision solutions to non-verbal problems)Decreased information processingDecreased decision-making

Sensory Processing Regulation5 Senses

Processing Issue

Touch Me/Touch Me Not

Pain Management Regulation

???

Psychosocial Implications Biological Family

Increased risk of neglect/abuse in addicted households20% increase in maltreatment in cocaine-exposed

infants with biological parents 60-90% of drug addicts may have mental, emotional or

personality disorders, leading to poor parenting skills

Long Term Effects Nicotine Alcohol Marijuana Opiates Cocaine Metham-phetamine

Growth No consensus on effect

Strong effect

No effect No effect No consensus on effect

Unknown

Behavior Effect Strong effect

Effect Effect Effect Unknown

Cognition Effect Strong Effect

Effect No consensus on effect

Effect Unknown

Language Effect Effect No effect Unknown Effect Unknown

Achievement Effect Strong Effect

Effect Unknown No consensus on effect

Unknown

Summary of Effects of Intrauterine Drug Exposure

(Behnke, 2013)

Questions?

pszetterberg@etch.com