Neonatology - Neonatal Abstinence Syndrome Flashcards
What is neonatal abstinence syndrome?
Withdrawal syndromes in neonates where mothers used substances during pregnancy
What substances cause NAS?
Opiates
Methadone
Benzodiazepines
Cocaine
Amphetamines
Nicotine or cannabis
Alcohol
SSRIs
When does withdrawal symptoms from most opioids, diazepam, SSRIs and alcohol occur?
3 - 72 hours post birth
Methadone withdrawal and other benzodiazepines occur between 24 hours and 21 days
What CNS signs and symptoms are there in NAS?
Irritability
Increased tone
High pitched cry
Not settling
Tremors
Seizures
What vasomotor and respiratory symptoms are there in NAS?
Yawning
Sweating
Unstable temperature and pyrexia
Tachypnoea
What metabolic and GI symptoms are there in NAS?
Poor feeding
Regurgitation or vomiting
Hypoglycaemia
Loose stools with a sore nappy area
How is NAS managed?
Mothers that are known to have substance use should have an alert on their notes
Babies kept in hospital with a NAS chart for at least 3 days, 48 hours with SSRIs to monitor withdrawal symptoms
Urine sample to test for substances
Quiet, dim environment
What medical treatment options are available for severe symptoms in NAS?
- Oral morphine sulphate - opioid withdrawal
- Oral phenobarbitone - non-opioid withdrawal
Gradually weaned off oral treatment
SSRI purely supportive
What additional considerations should there be in NAS?
- Test for Hep B and C and HIV
- Safeguarding and social care involvement
- Safety-net for withdrawal signs and symptoms
- Follow up
- Support mother to stop using
- Check suitability for breastfeeding
