Neonatal Abstinence Syndrome

Question 1

What is the definition of ‘poor eating’ due to Neonatal Abstinence Syndrome (NAS)?

Answer 1

unable to coordinate feeding within 10 minutes of showing hunger

OR

unable to sustain feeding due to difficult latching/frantic root or suck for at least 10 minutes at breast

OR

unable to take 30 mL of formula due to opioid withdrawal symptoms

Question 2

When can Child Life be consulted for a baby with NAS?

Answer 2

When the child is term

Question 3

What is the recommended length of use for sound machines for treating babies with NAS?

Answer 3

30 min

• must take a break in-between sessions

Question 4

What is the first and second line pharmalogical treatment for babies with NAS who fail non-pharmalogical treatment?

Answer 4

1st - MORPHINE

2nd - CLONIDINE

Question 5

Can mom breastfeed NAS baby if actively taking Subutex?

Answer 5

YES

Question 6

What are the 4 components of the ESC order set for NAS babies?

Answer 6

P - physical therapy
O - occupational therapy
M - music therapy
S - speech therapy

Question 7

What is the definition of ‘poor sleep’ due to Neonatal Abstinence Syndrome (NAS)?

Answer 7

sleep <1 hour after eating due to NAS symptoms (fussiness, restlessness, inc. startle, tremors, etc)

Question 8

What is the definition of “poor consoling’ due to Neonatal Abstinence Syndrome (NAS)?

Answer 8

unable to console within 10 minutes due to NAS, despite effectively providing support interventions

Question 9

When would a Parent/Caregiver huddle occur vs a Full Team huddle for a child with NAS?

Answer 9

P/C Huddle - 1+ yes response for ESC
- occurs once every 12 hours

FT Huddle - 1+ yes response for x3 consecutive evaluations

Question 10

Who is involved in a Parent/Caregiver huddle vs a Full Team huddle?

Answer 10

P/C huddle - bedside RN and parents/guardians

FT huddle - MNB team + NICU team + parents/guardians

Question 11

What are the goals of Parent/Caregiver huddle vs Full Team huddle?

Answer 11

P/C = optimize non-pharma interventions and monitor closely

FT = maximize non-pharma interventions, monitor closely, determine if pharmacologic intervention is necessary

Question 12

What is the initial PO morphine dose provided to NAS baby who has failed 3 consecutive ESC evaluations and was deemed worthy of medical intervention?

Answer 12

one time 0.03mg/kg/dose PO

Question 13

Where must IV or tube morphine be provided for a baby with NAS?

Answer 13

in the NICU

• PO can be given in MNB

Question 14

If NAS baby is moved to NICU and continues to have symptoms despite one time oral morphine dose, what PRN morphine formulations can be given? (2)

Answer 14

0.03 mg/kg/dose ORAL q4h PRN

OR

0.02 mg/kg/dose IV q4h PRN

Question 15

If NAS baby in NICU has had 3+ doses of PRN morphine, what is the next step in treatment?

Answer 15

switch to scheduled morphine doses

SAME DOSAGE as PRN morphine rates

Question 16

If NAS baby in NICU on scheduled morphine has 3+ ‘Yes” assessments during ESC evaluation, what is the next step in treatment? (2)

Answer 16

1. INCREASE morphine dosage
   
   • by 0.02 mg/kg dosage PO or by 0.01 mg/kg dosage IV
2. ADD CLONIDINE adjunct therapy
   
   • consider if morphine dose >0.1 mg/kg/dose q4h PO

Question 17

What is the initial dose of Clonidine provided to NAS baby for adjuvant therapy?

How much is it titrated by and when?

Answer 17

1 mcg/kg/dose PO q8h

• titrate by 0.5 mcg/kg/dose q24h as needed

Question 18

What is the MAX dose of Clonidine that can be given to a baby with NAS?

Answer 18

4 mcg/kg/dose

Question 19

If NICU parents stay at bedside and participate in care, do they have to pay for meals while at the hospital?

Answer 19

NO