Neonatal Abstinence Syndrome Paper

You are called to the room and find Michael 2 hours old has been very irritable and spitting up large amounts of formula. He is very jittery. You do not know the maternal history before coming into the room so you advise the mother that you would like to return the baby to the nursery for an assessment and monitoring. In the medical record you focus on prenatal history. You witness the baby having some significant tremors. What would you suspect? Michaels VS are: T (axillary) – 36.0, RR- 70, HR- 166, he is very alert, irritable, and does not console easily. Is moving constantly and sucking very vigorous on the pacifier you provide for comfort. You place the baby under the warmer and obtain what labs? It is determined that this baby is going through opioid withdrawal. Neonatal Abstinence Syndrome requires close observation and scoring. Methadone may be used. Neonatal Abstinence Syndrome Shows both the signs of withdrawal, scoring and the nursing care of a baby with Neonatal Abstinence Syndrome. What is your feeling and knowledge regarding care of the baby experiencing Neonatal Abstinence Syndrome? You must have a reference and in text citation Neonatal Abstinence Syndrome Paper

Introduction

NAS is a set of conditions for babies who withdraw from drugs they were exposed to in the uterus before birth. Pregnant women who take opioids, antidepressants, barbiturates, or benzodiazepines as sleeping pills expose their fetus to this condition. These drugs pass the uteroplacental and get into the fetal circulation and initiate the chemical pathways. Prolonged use encourages dependence for both the mother and the fetus; thus developing withdrawal symptoms at birth (Wachman et al., 2018). Drugs commonly associated include, codeine, hydrocodone, (Vicodin), Morphine, oxycodone and tramadol. Heroin is the street opioid drug that ignites the same pathway.Neonatal Abstinence Syndrome Paper

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Case Overview

This care presents Michael 2hours old neonate who is alert, very irritable and spitting up large amounts of formula, tremors, does not console easily, is moving constantly and sucking very vigorous on the pacifier you provide for comfort. His vital signs are T (axill.ary) – 36.0, RR- 70, HR- 166.

Symptoms of NAS

(Wachman et al., 2018), neonates with this condition present with, tremors, convulsions, overactive reflexes, irritability, fast breathing, fever, trouble sleeping, vomiting and diarrhea. Babies with this condition may have serious birth complications, including low birth weight, jaundice, seizures and Sudden infant death syndrome (SIDS). Other complications may involve developmental delays and late-stage systemic conditions.

Investigations

Care providers will need perform a Finnegan scoring system to grade the severity of the condition, usually done at 2 hours of life. This scoring system assesses 25 items and total score of 31. Babies who score more than 8 points are initiated on pharmacotherapy (Gomez-Pomar et al. 2017). Additionally, a drug screen on urine and first bowel movements (meconium) is done to ascertain the presence of drugs in the baby’s body. The nurse should also perform a CBC count with differential and platelets, obtain a serum glucose level and serum calcium level.

Treatment and Supportive Management

Neonates with severe symptoms are prescribed methadone P.O. 0.2mg/kg B.D. This dose is reduced by 10-20% weekly for 4-6 weeks depending on the baby’s prognosis. Alternatively, neonates may be prescribed Morphine which should be initiated at 0.03 mg/kg/dose P.O. every 4 hours. The dose may be increased by 10% every 12 hours until withdrawal symptoms are controlled (Raffaeli et al., 2017). Pharmacologic therapy promotes the reduction of withdrawal symptoms and the achievement of the average life of the neonate.Neonatal Abstinence Syndrome Paper

Raffaeli et al., 2017), such neonates also require supportive management as the primary and secondary intervention. First, should be managed in the well-baby nursery. The nursery show has low-stimulation to reduce agitation and restlessness. The mother or immediate parent should be readily available to provide non-pharmacologic care such as holding, swaddling, rocking and when the baby cries. Breastfeeding and or feeding should be frequent unless restricted.

References

.Gomez-Pomar, E., Christian, A., Devlin, L., Ibonia, K. T., Concina, V. A., Bada, H., & Westgate, P. M. (2017). Analysis of the factors that influence the Finnegan Neonatal Abstinence Scoring System. Journal of Perinatology, 37(7), 814-817.

Raffaeli, G., Cavallaro, G., Allegaert, K., Wildschut, E. D., Fumagalli, M., Agosti, M., … & Mosca, F. (2017). Neonatal abstinence syndrome: update on diagnostic and therapeutic strategies. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 37(7), 814-823.

Wachman, E. M., Schiff, D. M., & Silverstein, M. (2018). Neonatal abstinence syndrome: advances in diagnosis and treatment. Jama, 319(13), 1362-1374 Neonatal Abstinence Syndrome Paper