Chapter 19: Neonatal Abstinence Syndrome (NAS) (Newborn)

Question 1

Neonatal Abstinence Syndrome (NAS)

Answer 1

occurs from female IV drug abusers
-an infant of a drug-abusing mother (IDAM), is a newborn who has been exposed to drugs in the intrauterine environment, which can cause withdrawal symptoms in the extrauterine environment
>drugs that are abused have low molecular weight and transfer easily across the placenta

Question 2

Signs and Symptoms of NAS

Answer 2

• irritability
• tremors
• wakefulness
• uncoordinated feeding pattern
• loose stools
• yawning or hiccups
• poor weight gain
• hypertonia
• seizures
• exaggerated rooting reflex
• regurgitation and vomiting
• tachypnea or apnea
• sneezing and stuffy nose
• lacrimation and profuse sweating

Question 3

Diagnosis

Answer 3

laboratory tests are done to reveal if the drugs are in the newborns system

• urine tests done but reflect only the last few days of intrauterine environmental exposure
• newborns meconium stool and hair specimens are being used more to test for drugs in the newborns system; these specimens can be obtained up to 3 days and reflect a longer period of time of intrauterine exposure than urine testing

Question 4

Prevention

Answer 4

good prenatal care is needed with referral to substance abuse treatment center

Question 5

Nursing Care

Answer 5

-nursing challenge because they sleep very little and are very irritable
-provide quiet dark environment to promote sleep
-gently rock and hold the infant to provide comfort and security
-assessed every 3 hours using a neonatal abstinence scoring tool; scores greater than 7 for 3 consecutive scorings are uncomfortable and need to be treated with medication to decrease the severity of the withdrawal effects
>mothers addicted to methadone sometimes encouraged to breastfeed to offset withdrawal symptoms in newborns

Question 6

NAS and Naloxone

Answer 6

naloxone use may increase the severity of drug withdrawal in an infant of a drug abusing mother
>if the mother is a suspected drug user, naloxone should NOT be used
>if an infant of a drug abusing mother is in respiratory distress at the time of delivery, use positive pressure oxygen to resuscitate newborn

Question 7

Medication used to treat an Infant of a Drug-Abusing MOther

Answer 7

• paregoric (Camphorated Tincture of Opium)
• phenobarbital (Luminal)
• clonidine (Catapres)
• chlorpromazine (Thorazine)
• diazepam (Valium)
• methadone (Dolophine)