Transcript Neonatal Abstinence Syndrome: A Family Centered Approach

Neonatal Abstinence
Syndrome: A Family Centered
Approach to Care
Kelly Outlaw, M.S., CCLS
Objectives
1 - Attendees will learn what Neonatal
Abstinence Syndrome is
2 - Attendees will identify the unique
psychosocial needs of the infant and
mother/caregiver
3 - Attendees will understand the challenges
of working with this population
4 - Attendees will learn techniques to support
the NAS infant in the NICU
5 - Attendees will identify opportunities to
empower and promote infant and mother/
caregiver bonding
Neonatal Abstinence Syndrome (NAS)
“As caregivers, our responsibility lies in doing all we can, to
identify drug affected infants and to ensure that they are
provided the care and protection each one deserves.”
What is Neonatal Abstinence Syndrome (NAS)?
Neonatal Abstinence Syndrome (NAS) is a group of
problems that occur in a newborn who was exposed to
additive illegal or prescription drugs while in the
mother’s womb. These and other drugs pass through
the placenta – the organ that connects the baby to it’s
mother in the womb – and reach the baby. The baby
becomes addicted along with the mother.
Neonatal Withdrawal Symptoms
• CNS
Disturbed sleep patterns, hyperactivity, tremors, increased muscle tone,
myoclonic jerks, shrill cry, convulsions
• Metabolic
fever, hypoglycemia, mottling, sweating, yawning, vasomotor instability
• Respiratory
Nasal flaring, sneezing, tachypnea, hiccups
• Gastrointestinal
Excessive sucking, poor feeding, vomiting, diarrhea
Common Drugs Found in NAS Babies
Opiates
• Methadone, Oxycodone, OxyCotin, Vicodin, Heroine
Psychotropic
• Antidepressants
Stimulants
• Amphetamines
Depressants, Sedative-hypnotics
• Barbiturates, Quaaludes, Tranquilizers
Half Life and Symptom Presentation
Opiates
shorter half-lives, symptoms may present within 72 hours of
birth
Depressants, Sedative-hypnotics
longer half-lives, symptoms may present 2-4 weeks after birth
Signs and Tests to Diagnose NAS
Finnegan score which assigns points based on
each symptom and it’s severity. The infants score
can help determine treatment
Lipsitz Scale
Toxicology of first bowel movement (meconium)
Urine test (urinalysis)
Reporting Substance Exposed Newborns
to CPS
Federal law now requires under the Keeping
Children and Families Safe Act of 2003
that all health care providers refer all
infants identified as drug exposed to Child
Protective Services. At this time fewer than
half of the states have laws requiring
reporting. This means that many states
may not have laws requiring these infants
to be reported.
Medical Management
•Babies stay in the NICU anywhere from several days
to several months
•Babies may receive a combination of oral Morphine,
Phenobarbital, Methadone, or Seizure medication
•Some babies who have very poor feeding may get an
NG tube
Non Pharmalogical Management
•Therapeutic Handling
•Controlling the Babies External Environment
•Teaching the Parent/Caregiver Handling and
Bonding techniques
Needs
Psychosocial
Developmental
• Infant
• Infant
• Mother
• Mother
• Caregiver
• Caregiver
• Family
• Family
Interventions the Child Life Specialist Can
use in the NICU
• Environmental Support
• Therapeutic Handling
• Infant Massage
• Education on Infant Development
• Education on Shaken Baby Syndrome
• Car Seat Safety
Other Services Offered
• Prenatal Education Classes
• Education to Hospital Staff
Pediatric unit, NICU, ER
• Community Education
– NOPE (Narcotic Overdose Prevention and Education)
– Education to Pediatricians on NAS symptoms
– Education to Obstetricians
Challenges Faced by Healthcare Team Working
With NAS Infants and Their Families
References
•
Bandstra, E. S., Morrow, C. E., Mansoor, E., & Accornero, V.H. (2010).
Prenatal drug exposure: infant and toddler outcomes. Journal of
Addicitve Diseases, 29, 245- 258.
•
Beachy, J.M. (2003). Premature infant massage in the NICU. Neonatal
Network Journal, 22(3), 39-45.
•
Hernandez-Reif, M., Diego, M., & Field, T. (2007). Preterm infants show
reduced stress behaviors and activity after 5 days of massage therapy.
Infant Behavior & Development, 30(4), 557-561.
•
Karp, H. (2002). The happiest baby on the block. New York, NY: Random
House.
•
McGlade, A., Ware, R., & Crawford, M. (2009). Child protection
outcomes for infants of substance-using mothers: a matched-cohort
study. Pediatrics, 124(1),285-293.
References
•
Murphy-Oikonen, J., Brownlee, K., Montelpare, W., & Gerlach, K. (2010).
The experience of NICU nurses in caring for infants with neonatal
abstinence syndrome. Neonatal Network, 29(5), 307-313.
•
Rigg, K. K., & Ibanez, G. E. (2010). Motivations for non-medical
prescription drug use: a mixed methods analysis. Journal of Substance
Abuse Treatment, 39, 236-247.
•
Valez, M., & Jansson, L. M. (2008). The opioid dependent mother and
newborn dyad: non-pharmacologic care. Journal of Addiction Medicine,
3, 113-120, doi:10.1097.
Kelly Outlaw MS, CCLS
St. Joseph’s Children’s Hospital
(813) 554-8509
[email protected]