Management of Neonatal Abstinence Syndrome in the Newborn Nursery

摘要

Maternal drug use and neonatal abstinence syndrome (NAS) are being seen across the United States. NAS occurs with withdrawal disturbances in response to the cessation of the pregnancy exposure. The clinical presentation of a newborn with NAS can include gastrointestinal, neurologic, vasomotor and respiratory symptoms. Assessment of newborns with NAS can often present as a challenge to maternal-child nurses. Treatment can include supportive care as well as phar-macologic therapies. Consider the following scenario: You're a nurse assigned to the Mother/Baby Unit today. During team rounds with the pediatrician, you identify that one of the couplet assignments includes a mother enrolled in a methadone program whose newborn is now exhibiting signs of withdrawal. Presently the infant is scoring for high pitch of cry, short sleeping cycles and tremulous activity of extremities. As a maternal-child nurse, you recognize the epidemic surfacing in the United States of maternal drug use during pregnancy. Studies during 2000 to 2009 revealed the annual rate of neonatal abstinence syndrome (NAS) diagnosis increased almost threefold and maternal opiate use increased approximately fivefold (Kellogg, Rose, Harms, & Watson, 2011). Use or abuse of prescribed pain medications, illicit drugs and selective serotonin reuptake inhibitors (SSRIs) can potentially expose a fetus or newborn to harm. Substance use during pregnancy is associated with birth defects, low birth weight, premature birth, NAS, seizures, alterations in brain organization and neurobehavioral/cognitive deficits (Bada et al., 2005).