Neonatal withdrawal

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Neonatal withdrawal or neonatal aberration syndrome ( NAS ) is a postpartum withdrawal syndrome caused by exposure in the uterus to drug dependence. There are two types of NAS: prenatal and postnatal. Prenatal NAS is caused by discontinuation of drugs taken by pregnant women, while postnatal NAS is caused by the immediate cessation of the drug in infants.

Video Neonatal withdrawal

Signs and symptoms

Symptoms often begin within one to three days after birth, but it can take up to a week to appear. Therefore, infants may need to stay in the hospital for observation and monitoring for up to one week. Withdraw from different drugs, including prescribed drugs, and nicotine from smoking, produce their own signs and symptoms in infants. The neonatal abstinence syndrome can occur when pregnant women take opioids such as heroin, codeine, oxycodone, methadone or buprenorphine. Benzodiazepines, barbiturates, and certain antidepressants (SSRIs) can cause dependence on the baby while in the womb. The severity of neonatal withdrawal symptoms may be affected by the administration route used by the mother. Metabolism and drug elimination from the mother's system, and the length of time the drug is taken, will also have an impact on the development of withdrawal symptoms in the newborn. More severe findings may include acting easily irritability or anxiety, eating problems, and diarrhea. Symptoms vary depending on the substance used. A history of substance abuse in the mother before birth increases the likelihood that the baby will experience withdrawal symptoms.

Generally, the withdrawn baby has a distinctive cry. It can be described as high notes, non-stop and shrill. Newborn withdrawal from drugs or alcohol may be hypertonic and has a seizure. Seizure, increased Moro reflex, tremor, irritability, and disturbed sleep patterns can be observed.

Respiratory symptoms of withdrawal include temperatures greater than normal, tachypnea, apnea, nasal congestion, nasal flares, glowing skin, and evaporate.

Withdrawal may produce gastro-intestinal symptoms such as poor appetite, regurgitation, vomiting and diarrhea. Sucking reflexes can be intense and uncoordinated. Babies of mothers who use drug dependency during their pregnancy may have long-term problems.

Methadone Withdrawal

Infants who withdraw from methadone may experience difficulty sleeping, seizures and a higher risk of death from sudden infant death syndrome. Methadone withdrawal occurs after 7-14 days. If a child is premature they have a lower risk of severe symptoms. Those born & lt; 35 weeks after pregnancy had a CNS abstinence score lower than the term infant. Perhaps because premature babies may be exposed to fewer drugs, have an immature nervous system and a lower adipose tissue.

Heroin withdrawal

Infants born with heroin dependence are more likely to be premature and have meconium staining. Heroin withdrawal is seen within 48-72 hours of birth.

Amphetamine Withdrawal

Infants born with amphetamine dependence are more likely to be premature. May be small for gestational age. It may show signs of respiratory distress, infection, excessive shock reflex, sleep disorder disorder. Once the baby is born, it may have a poor weight gain, frequent infections, developmental delays and emotional problems.

Alcohol withdrawal

Although the use of alcohol by the mother before birth can cause serious long-term effects on newborns, babies can also be born with dependence on alcohol. Alcohol withdrawal in the newborn produces seizures, increased muscle tone, excessive shock reflex, irritability and anxiety.

Withdrawal of marijuana

Withdrawal from marijuana can initiate premature birth and meconium staining.

Lysergic_acid_diethylamide_.28LSD.29 "> Lysergic acid diethylamide (LSD)

The use of LSD by the mother produces symptoms. Because polydrug abuse often accompanies the use of LSD, the symptoms may be disguised. Abnormal feeding, tremor and hyponia can be seen in infants. Withdrawal symptoms manifest as hyponia, tremors, poor feeding, and abnormal eating patterns.

Caffeine and nicotine

The symptoms of nicotine withdrawal can become apparent for five days after delivery and last for months. The symptoms of nicotine withdrawal in infants are stimulation and hypertonic. Vomiting, excessive crying and difficulty sleeping can be seen in infants who withdraw from caffeine.

Maps Neonatal withdrawal

Cause

The drugs involved may, for example, opioids, selective serotonin reuptake inhibitors (SSRIs), ethanol and benzodiazepines. Neonatal Abstinence Syndrome does not occur in exposure to prenatal cocaine. Prematurity and exposure to other drugs can actually be the cause of symptoms.

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Mechanism

Drugs and chemicals cross the placenta that connects the baby to its mother in the uterus. The baby becomes dependent on the medicine with his mother. If the mother continues to use the drug within a week or more before delivery, the baby will depend on the drug at birth. Because the baby no longer gets the drug after birth, withdrawal symptoms can occur because the drug is slowly cleared from the baby system. Nicotine, drugs and alcohol have side effects associated with higher unsafe doses, but neonates may respond differently. Newborns are less able to metabolize the drug and therefore the substance remains in their system for a relatively longer time when compared with those who are older and have fully functional kidneys and kidneys.

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Diagnosis

Confirming the withdrawal of the neonate can be assessed from obtaining a detailed medical history of the mother. In some cases the withdrawal of neonatal drugs may be misinterpreted as a central nervous system disorder. Usually the tests ordered are CBC, hair analysis, drug screens (mother and baby), thyroid levels, electrolytes, and blood glucose. Chest x-ray may confirm or weaken the presence of heart defects. Diagnosis for infants with withdrawal signs can be confirmed with a drug test from a baby's urine or stool. Maternal urine will also be tested.

There are at least two different scoring systems for neonatal withdrawal syndrome. One of the difficulties with both is that developed to assess opiate withdrawal. Finnegan's rating system is mostly used.

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Prevention

Neonatal withdrawal is prevented by mothers who do not abuse substances. In some cases, prescribed medications may have to be discontinued during pregnancy to prevent addiction by infants. Early pre-natal care can identify addictive behaviors in the mother and family system. Reference to care centers is appropriate. Some prescription drugs should not be stopped without medical supervision, or hazards may occur. Women can discuss all drugs, and use alcohol and tobacco with their healthcare providers and get help to help stop drug use as soon as possible. An indication that a woman needs help if she:

• Using non-medical drugs
• Using drugs not prescribed for him
• Using alcohol or tobacco

If she is already pregnant and takes drugs or medications that are not prescribed to her, she can talk to the health care provider about the best way to keep the baby safe. Some medications should not be discontinued without medical supervision, or hazards may occur. Your health care provider will know the best way to manage risk.

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Treatment

Treatment depends on the medication involved, overall infant health, absence score and whether the baby is born full or premature. The doctor will carefully monitor the newborn baby up to one week after birth for signs of withdrawal, eating problems, and weight gain. Vomiting or highly dehydrated babies may need to get fluid through a vein (IV).

Some babies with severe symptoms require medications such as methadone and morphine to treat withdrawal symptoms. These babies may have to stay in the hospital for weeks or months after birth. The goal of treatment is to prescribe a baby drug similar to that used by the mother during pregnancy and slowly reduce the dose over time. It helps wean babies out of medication and reduce some withdrawal symptoms.

If the symptoms are severe, especially if other drugs are used, a second drug such as phenobarbital or clonidine may be added. Breastfeeding can also help if the mother is in a methadone or buprenorphine treatment program without the use of other drugs.

Infants with this condition often experience severe diaper rash or other areas of skin damage. This requires care with a special ointment or cream. Babies may also have problems with eating or slow growth. These problems may require a higher calorie intake that provides greater nutrition and smaller portions that are given more frequently. The goal of management is to minimize negative results and encourage normal development.

Support

Non-drug-based approaches to treat neonatal symptoms include infant membangun in a blanket, minimizing environmental stimuli, and monitoring sleep and eating patterns. Breastfeeding improves infant bonding and bonding and is associated with decreased need for medication. This approach can reduce the severity of NAS and lead to shorter hospital stays.

Medication

Drugs are used to relieve fever, seizures, and weight loss or dehydration. When drugs used for withdrawal of opiates in newborns are considered necessary, opiates are the treatment of choice; they slowly tapering to wean babies from opiates. Phenobarbital is sometimes used as an alternative but less effective in suppressing seizures; However, phenobarbital is superior to diazepam for withdrawal symptoms of neonatal opiates. In the case of hypnotic sedative-neonatal pullers, phenobarbital is the treatment of choice. Clonidine is an additional therapy that appears.

Opioids such as neonatal and methadone morphine solutions are commonly used to treat clinical symptoms of breaking opiate drugs, but may extend neonatal drug exposure and duration of hospitalization. A study showed shorter weaning duration in methadone-treated infants compared with those treated with dilute opium tinctures. When compared to morphine, methadone has a longer half-life in children, allowing less frequent dosing intervals and stable serum concentrations to prevent neonatal withdrawal symptoms.

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Epidemiology

A 2012 study from the University of Michigan and the University of Pittsburgh published in the Journal of the American Medical Association analyzed information about 7.4 million discharges from 4,121 hospitals in 44 states to measure trends and related costs with NAS over the last decade. This study shows that between 2000 and 2009, the number of mothers who took opiates increased from 1.19 to 5.63 per 1,000 births per year. Newborns with NAS are 19% more likely than all other hospital births to have low birth weight and 30% prefer to have respiratory complications. Between 2000 and 2009, the total hospital costs for the NAS case, adjusted for inflation, is expected to increase from $ 190 million to $ 720 million.

The neonatal abstinence syndrome in Canada is significant.

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Complications

Drug and alcohol use during pregnancy can cause many health problems in infants other than NAS. This may include:

• Birth defects
• Low birth weight
• Premature birth
• Small head circumference
• Sudden infant death syndrome (SIDS)
• Issues with development and behavior

Treatment of neonatal abstinence syndrome may last from 1 week to 6 months. Even after medical treatment for the NAS is completed and the baby leaves the hospital, they may require continued care for several weeks or months.

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References

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Bibliography

Henry, Norma (2016). Rn Maternal Newborn Care . Stilwell, KS: Institute of Assessment Technology. ISBN: 9781565335691.

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