1 / 14

Neonatal Abstinence Syndrome

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.

luna
Download Presentation

Neonatal Abstinence Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Neonatal Abstinence Syndrome Karen Estrella-Ramadan 06/25/2012

  2. 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

  3. Opioids and pregnancy • Repetitive use and withdrawal leads to ftal hypoxia, fetal demise, IUGR, SGA • Medication-assisted tx with methadone • Long half life • With advance pregnancy is metabolized faster and higher doses are required

  4. Neonatal Abstinence Syndrome • Timing • Heroin: 48-72hrs • Methadone: 4 days • Screening: • Newborn urine: • 24-48hrs • Amphetamines, barbiturates, benzos, cocaine, marijuana, some opioids-my not include methadone or oxycodone • Meconium toxicology • First 3-4 days • Ampehtamines, opiods, cocaine, marijuana

  5. Clinical Features NEUROLOGICAL: • Tremors • Irritability • Increased wakefulness • High-pitched crying • Increased muscle tone • Hyperactive deep tendon reflexes • Exaggerated Moro reflex • Seizures • Frequent yawning and sneezing GI DYSFUNCTION: • Poor feeding • Uncoordinated and constant sucking • Vomiting • Diarrhea • Dehydration • Poor weight gain AUTONOMIC SIGNS: • Increased sweating • Nasal stuffiness • Fever • Mottling • Temperature instability

  6. Treatment • ~50-70% of infants will require tx • At delivery, NO naloxone= seizures • SCORING (modified Finnegan) • Before feeding

  7. 1. Supportive • Encourage maternal and paternal involvement • Decrease stimulation: no light, no loud sounds, examination • Swaddling, soothing, rocking (vertical) • Non-nutritive sucking: Pacifier • Skin-skin contact: Kangaroo care • Skin care: lotion to areas of abrassion • Frequent feedings: increase caloric intake (150-250 cal/kg/day) • May allow BF if neg Utox in mother, HIV neg

  8. 2. Pharmacological • Scoring >9 (x3: before and after feeding) or 2 >than 12 • Short acting opioid: MORPHINE (0.4 mg/ml) • Start with 0.03 mg/kg/day • 0.2 mg po q4hrs • Scoring: q8-12hrs • If still high: increase by 0.16mg/kg/day q3hrs (max 0.8mg/kg/day) • Monitor: • Over-sedation, decreased arousal, resp depression • Wean after 48hrs on scores <6 • Decrease 20% of daily dose • Continue scoring • Wean after 28-72hrs on scores <6, and less freq feedings • Decrease 20% of daily dose • d/c morphine • Once sub therapeutic dose is achieved, observe for 24-28 hrs off morphine • If sz: diff dx workup • Add phenobarbital if no control of symptoms with max dosing

  9. Discharge • Off morphine for 24hrs with score <6 • Adequate nutrition • No more than 10% wt loss • SW clearance • f/u with PMD

  10. Other things to consider • Screens for: • Syphilis • Hepatitis B • Hepatitis C • HIV • Tb • DV

  11. Differential dx • Sepsis • Hypoglycemia • Hypocalcemia • hypomagnesemia • Hyperthyroidism • Perinatal asphyxia • IVH

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

More Related