NAS Flashcards
What is NAS?
Neonatal Abstinance Syndrome
Drug withdrawal in the infant
General disorder presenting a clinical picture of *
Drugs include opiates, cocaine and derivatives, amphetamines, alcohol
Abnormal neurobehavioural patternts - high intakes of majiuana, inhalants, caffeine, new SSRI antidepressants
NAS symptoms
- CNS: tremors, high pitched cry, irritable, sleep disturbance
- Autonomic: sneezing, yawning, fever, sweating, mottling
- GI: poor feeding, loose stools/diarrhoea, vomiting, possetting
- Respiratory system: tachypnoea, nasal flaring, chest recession
NAS diagnosis
Maternal history of substance abuse during pregnancy AND subsequent neonatal symptoms of withdrawal
Severity of neonatal symptoms using a score chart - NAS Score. Validated screening tool. Assess from birth to 4th day of life.
When to treat NAS?
3 consecutive scores averaging >=8 or 12 for 2 consecutive scores
2 hourly scoring while scores >=8, then 4 hourly until infant is stable.
Involve parents
How to settle NAS babies
Dark, quiet room
Relaxation baths
Dummies
Skin to skin and swaddling
Small frequent feedings
Pharmacological treatment for NAS
Phenobarbitone and/or Morphine
Weaning from morphine will be required
*Parental education for parents whose baby is experiencing NAS
- Involve parents in NAS scoring
- Reassue parents that this won’t last forever. Could last for a week and possibly up to six months. Over this time symptoms gradually decrease in intensity.
- Once at home, baby may continue to experience difficulty with attachment during BF, colic, poor sleeping patterns and slow weight gain.
- Provide them with some strategies for calming baby (.e.g. relaxation baths, dummies, swaddling, small frequent feeds, comforting techniques like baby wearing, white noise, movement, dark room, comfortable temperature).
- Nappy rash cream, cloths for vomit,
- Early contact with CHN - make them aware.
- Mum to care for herself too - e.g. rest, nourishment, etc.
- When to seek help - “If you are concerned or worried about your baby’s health tell your partner, WANDAS, GP, Child Health Nurse or Perth Children’s Hospital.”
Calming Strategies: Prolonged crying
- Hold baby close to body
- Decrease loud noises, bright lights, excessive handling, etc
- Humming, gentle rocking may help
Calming Strategies: Sleeplessness
- Reduce noise, bright lights, patting or touching baby too much
- Soft, gentle music, rocking may help
- Clean nappy/dry bottom - check for nappy rash / skin irritation
- Nappy rash cream as needed
- Feed on demand
Calming Strategies: Excessive sucking of fists
- Cover hands with gloves or mittens if skin becomes damaged
- Keep areas of damaged skin clean (avoid lotiions/creams as baby may suck them)
Calming Strategies: Difficult or poor feeding
- Feed small amounts often
- Feed in quiet, calm surroundings with minimal noise and disturbance
- Allow time for resting between sucking
Calming Strategies: Sneezing, stuffy nose, breathing troubles
- Keep nose and mouth clean
- Avoid overdressing or wrapping too tightly
- Feed baby slowly, sllowing for rest periods between feeds
- Smaller feeds more often may help
- Keep baby in semi-sitting position, well supported and supervised
- Don’t place baby to sleep on its tummy
Calming Strategies: Regurgitation / Vomiting
- Burp each time he/she stops sucking and after the feed
- Support the baby’s cheeks and lower jaw to enhance sucking / swallowing efforts
- Keep baby clean and bedding free of vomit - smell may increase the problem and may irritate baby’s skin
Calming Strategies: Hyperactivity
- Use soft flannel blankets or short haired sheep skin co vered by a cotton sheet for baby’s comfort
Calming Strategies: Trembling
- Keep baby in a warm quiet room
- Avoid excessive handing of baby
