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SUBSTANCE ABUSE The Drug-Exposed Infant

SUBSTANCE ABUSE The Drug-Exposed Infant. Authored by: Kathy McKee MS, RNC. OBJECTIVES. List three physiological or behavioral signs of an infant exposed to drugs in utero Describe use of Neonatal Abstinence Scoring

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SUBSTANCE ABUSE The Drug-Exposed Infant

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  1. SUBSTANCE ABUSE The Drug-Exposed Infant Authored by: Kathy McKee MS, RNC

  2. OBJECTIVES • List three physiological or behavioral signs of an infant exposed to drugs in utero • Describe use of Neonatal Abstinence Scoring • Discuss nursing interventions appropriate for infants exposed to drugs in utero

  3. The Statistics • National Institute on Drug Abuse • 500,000 – 700,000 affected babies annually in the United States • Washington State • 12,000 drug affected babies each year

  4. Guidelines for Testing and Reporting • Screening • It is the responsibility of every practice to make sure that all pregnant and postpartum women are screened for substance use (WA State Dept of Health) • Testing • Drug testing is based on specific criteria and medical indicators • Reporting • Reports of prenatal substance exposure shall not be construed to be child abuse or neglect and shall not require prosecution of the mother

  5. Mom Risk Indicators No prenatal care Previous unexplained fetal demise Precipitous labor Abruptio placentae Hypertensive episodes Severe mood swings Repeated spontaneous abortions Consent Baby Risk Indicators Jittery with normal glucose level Marked irritability Preterm birth Unexplained seizures or apneic spells Unexplained IUGR Neurobehavioral abnormalities Congenital abnormalities Signs of NAS Consent Testing

  6. The Drug-exposed Infant • Transient effects • Teratogenic effects • Dysmorphic • Behavioral • Confounding variables • Maternal health, socioeconomic status, lifestyle • Drug used/Poly-drug use • Use in relation to gestational age • Time used prior to delivery

  7. Common Findings in Drug Exposed Infants • Hypersensitivity to stimuli • Abnormal muscle tone • Sleep Problems • Feeding Problems • GI Problems

  8. Alcohol • Fetal Alcohol Spectrum Disorders/Alcohol Related Birth Defects • Growth Restriction • Facial Dysmorphism • Microcephaly • Short palpebral fissures • Hypoplastic philtrum • Thin upper lip • CNS Dysfunction • Neurological symptoms • Cognitive & behavioral signs

  9. Nicotine • 17% of pregnant women between the ages of 15 and 44 smoke • Adverse Effects • Decreased blood flow through the placenta • Low birth weight • Neurobehavioral impact • Increased respiratory tract illnesses • Sudden infant death syndrome

  10. Cocaine • Stimulant • Tachycardia • Hypertension • Decreased blood flow and oxygen delivery to fetus • Increased uterine contractions

  11. Effect of Cocaine on the Infant • Possible association with: • Congenital heart defects • Urinary obstruction defects • Gastrointestinal obstruction • Irritability • Poor feeding • Decreased interaction • Disorganization • Sleep disturbances • Tremors • Sneezing • Tone abnormalities • High-pitched cry

  12. Methamphetamine • Potent stimulant • Vasoconstriction • Increased heart rate • Hyperthermia • Decreased appetite in user • Decreased oxygen and nutrient delivery through placenta • Prolonged circulation of drug in fetal circulation

  13. Poor state control Lethargic Poor feeding Disorganized suck No suck Irritable Abnormal tone Excoriated buttocks Effects of Methamphetamine on the Infant • Associated with: • Congenital brain lesions • Cleft lip • Cardiac defects • Low birth weight and reduced OFC • Hyperbilirubinemia

  14. Narcotics/Opiates • Morphine, Heroin, Methadone • Continued use will lead to profound physiologic and psychological addiction • Neonatal Abstinence Syndrome • Passive exposure in utero as a consequence of maternal addiction. • Iatrogenic exposure by the administration of narcotic analgesics to the neonate

  15. Neonatal Abstinence Syndrome • Generalized disorder characterized by 21 symptoms most commonly seen in withdrawing infants. • 2/3 of infants born to opiate-dependent women will exhibit signs of NAS • Time of onset varies • Symptoms vary

  16. Neonatal Abstinence Scoring • Assists in the detection of • Onset of withdrawal symptoms • Severity of symptoms • Response to intervention • Resolution of symptoms • Assess high risk infant • 2 hours after birth • Every 3-4 hours

  17. NAS Scoring • The Finnegan scale • If score is 8 or greater • Score every 2 hours for 24 hours • Scores > 8 on three consecutive scores • Evaluate need for medication • If intervention not needed by 72 hours • Scoring may be discontinued

  18. System Disturbances • Central Nervous System • Metabolic/Vasomotor/Respiratory • Gastrointestinal

  19. Central Nervous System • Cry • Sleep pattern • Exaggerated Moro Reflex • Tremors • Muscle tone • Excoriation • Myoclonic jerks • Convulsions

  20. Metabolic,Vasomotor, Respiratory • Sweating • Fever • Yawning • Mottling • Nasal stuffiness • Sneezing • Nasal flaring • Increased respiratory rate, retractions

  21. Gastrointestinal • Excessive sucking • Poor feeding • Regurgitation, projectile vomiting • Loose stools, watery stools

  22. Medicationsfor NAS • Morphine Sulfate • Phenobarbital • Ativan • Other

  23. Nursing Care of the Drug Exposed Infant • Careful Assessment • NAS Scoring (if opiate exposure) • Control of the environment • Feeding techniques • Therapeutic Handling • Swaddle • Clapping • Vertical rocking • C-position

  24. Nursing Care of the Drug Exposed Infant • Dealing with the family • Personal feelings • Public health issue vs. Crime • Involve in care—teach Opportunities for changing the addicted woman’s behavior and her view of health care providers can be influenced by the care she and her infant receive while hospitalized

  25. Questions ?

  26. References • Askin, Debbie Frasier (2001). Cocaine: Effects of in utero exposure on the fetus and neonate. The Journal of Perinatal and Neonatal Nursing, 14 (4), 83-102 • D’Apolito, Karen (2001). Prominence of withdrawal symptoms in polydrug-exposed infants. The Journal of Perinatal and Neonatal Nursing, 14 (4), 46-60. • Jorgensen, Katherine M. (1999). The drug-exposed infant: Physiology, signs, and symptoms. Central Lines, 15 (2), 1-11. • Ostrea, Enrique M. (2001). Understanding drug testing in the neonate and the role of meconium analysis. The Journal of Perinatal and Neonatal Nursing, 14 (4), 61-82. • Tillett, Jackie & Osborne, Kathryn (2001). Substance abuse by pregnant women: Legal and ethical concerns. The Journal of Perinatal and Neonatal Nursing, 14 (4), 1-11.

  27. Weiner, Susan M. & Finnegan, Loretta P. (2002). Drug withdrawal in the neonate. In Handbook of Neonatal Intensive Care 5th Ed. St. Louis, Missouri, Mosby, Inc. Wilbourne, Paula, Wallerstedt, Cheryl, Dorato, Veronica, & Curet, Luis B. (2001). Clinical management of methadone dependence during pregnancy. The Journal of Perinatal and Neonatal Nursing, 14 (4), 26-45. Guidelines for Testing and Reporting Drug Exposed Newborns in Washington State. Washington State Department of Health, 2006. Williams, Jill Schlabig (2006). The neurobehavioral legacy of prenatal tobacco exposure. NIDA.

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