Maternal Drug Use, Infant Exposure, and Neonatal Abstinence Syndrome

Question 1

Why is Neonatal abstinence syndrome (NAS) …?

Answer 1

Neonatal abstinence syndrome (NAS) can result from a variety of opioids including prescription opioids (e.g., hydrocodone), illicit opioids (e.g., heroin), or medication-assisted treatment (e.g., methadone).

Question 2

Drugs causing the greatest risk of NAS….?

Answer 2

Methadone

which becomes less with buprenorphine, followed by a long-acting opioid (MS Contin, morphine sulfate extended release), and then a short-acting opioid (hydrocodone)

Question 3

Timing of presentation presentation of NAS ….?

Answer 3

AAP recommends that all opioid-exposed infants be observed in the hospital for signs of withdrawal for 4 to 7 days after birth

Question 4

Which tool is used for Assessment of NAD …?

Answer 4

modified Finnegan Neonatal Abstinence Score Tool (NAST)

Question 5

Onset and Duration of Clinical Signs Consistent with Neonatal Withdrawa after alcohol use …?

Answer 5

Hyperactivity, crying, irritability, poor suck, tremors, seizures, poor sleeping pattern, hyperphagia, diaphoresis; onset of signs at birth

Onset of Signs: 3–12 hours

Duration of Signs: 18 months

Question 6

Excessive high-pitched cry……?

Answer 6

Unable to self-console in 15 seconds or continuous up to 5 minutes despite intervention

Question 7

Continuous highpitched cry…..?

Answer 7

Unable to self-console in 15 seconds or continuous >5 minutes despite intervention

Question 8

Hyperactive Moro reflex

Answer 8

Elicit from a quiet infant; jitteriness that is rhythmic, symmetric, and involuntary

Question 9

Markedly hyperactive Moro reflex…?

Answer 9

Elicit from a quiet infant; jitteriness that is rhythmic, symmetric, and involuntary AND clonus of hands/arms; may test at hands or feet if unclear (more than 8–10 beats)

Question 10

Increased muscle tone….?

Answer 10

Perform pull-to-sit maneuver if tolerated; no head lag with total body rigidity. Do not test while asleep or crying.

Question 11

Fever <101°F….?

Answer 11

37.2–38.3°C

Question 12

Fever >101°F

Answer 12

38.4°C and higher

Question 13

Frequent yawning

Answer 13

More than three to four times, individually or serially, over scoring interval/time period

Question 14

Poor feeding

Answer 14

Excessive sucking as above but infrequent or uncoordinated with feeding, or gulping with frequent rest periods to breathe

Question 15

Excessive sucking

Answer 15

Rooting with more than three attempts noted to suck fist, hand, or pacifier before or after feeding