Neonatal Abstinence Syndrome

Chiara was born to a drug-addicted mother at 32 weeks of gestation. Which findings may be present or develop in Chiara due to neonatal abstinence syndrome (NAS)? Select all that apply.

Lethargy and sleepiness
Developmental problems
Learning and behavior issues
Hearing and vision problems
Fussy and hard to soothe

Developmental problems
Learning and behavior issues
Hearing and vision problems
Fussy and hard to soothe
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Newborns with NAS face a variety of difficulties. They are irritable and difficult to soothe. They have an increased risk of developmental, hearing, and vision problems. Later, they could face learning and behavioral issues.

They typically will have difficulty sleeping and tend to be overstimulated and active (not lethargic)

Substantial (decreases or increases) in both neonatal abstinence syndrome (NAS) and maternal opioid use disorder have been observed in the last ten years. Newborns born to mothers who consume (licit and illicit or illicit) only medications during pregnancy can develop NAS.

Increase
Licit or illicit
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NAS and maternal opioid disorders have increased, and they can be caused by illicit or licit medications.
Medications include:​

opioids, such as heroin and prescribed medicines like codeine and oxycodone​

stimulants, such as amphetamines or cocaine​

antidepressant medicines, such as selective serotonin reuptake inhibitors (SSRIs)​

depressants, such as barbiturates, alcohol, or marijuana​

Women that use licit or illicit drugs should (stop right away or notify their provider) as soon as they find out they are pregnant. Quitting abruptly can (cause severe problems or benefit) the newborn.

Notify the provider
causes severe problems
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Pregnant women who use any of the drugs that can cause NAS should tell their provider right away, but they shouldn't stop taking the drug without getting guidance and treatment from their provider first.

Quitting suddenly (cold turkey) can cause severe problems for the baby, including death.

Women should discuss options for quitting with their provider. Getting treatment can help a client stop using drugs and is safer for the baby than getting no treatment at all. ​

Various recreational and illicit drug statistics reveal that we (do or do not) need more longer-term studies to assess the lasting effects of drug misuse on infants. ​
Many commonly misused drugs, including heroin, methadone, and cocaine (do or do not) cross the placenta. ​
Pregnant women should stop misusing drugs (before or after) they attend their first prenatal appointment. ​
Methadone withdrawal is (less or more) severe and (shorter or longer) than heroin withdrawal.

Do
Do
After
More
Longer
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More long-range studies are needed on the effects of marijuana, cocaine, and other substances used by mothers.

Most drugs cross the placenta, including marijuana, heroin, methadone, cocaine, and PCP.

Drug withdrawal is accompanied by fetal withdrawal, which can lead to fetal death, so the client should be under the care of a physician.

Methadone withdrawal is more severe and prolonged than heroin withdrawal.

What should nurses be aware of in order to provide optimal care to mothers who have a substance use disorder? Select all that apply.

No laboratory procedures are available that can identify the intrauterine drug exposure of the infant.

Mothers who abuse one substance will likely use or abuse another, thus compounding the infant's difficulties.

Early intervention can reduce the harm done to the fetus by the drug use.

Infants born to mothers with a substance use disorder are diagnosed with the same condition.

The Finnegan Neonatal Abstinence Score (FNAS) is designed to assess the damage the mother has done to herself.

Mothers who abuse one substance will likely use or abuse another, thus compounding the infant's difficulties.

Early intervention can reduce the harm done to the fetus by the drug use.
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Research has shown that early intervention with mothers who abuse drugs can decrease the harm done to the newborn.

There are many variables, but the sooner the mom can stop taking drugs or participate in a detox program, the better.

Mothers who abuse one medication are at risk of using additional drugs.

Infants of mothers with a substance use disorder may have some of the physiologic signs but are not considered to have a substance use disorder.

The Finnegan Neonatal Abstinence assessment is designed to assess the neurologic, behavioral, and stress/abstinence function of the neonate.

Newborn urine, hair, or meconium sampling may be used to identify an infant's intrauterine drug exposure.​

Nursing care for infants exposed to substances during pregnancy requires a multisystem approach. What is the initial step in the provision of this care?

Adjust environmental stimuli

Administer medication treatment

​Adjust fluids to support nutrition and maintenance of fluid and electrolyte balance

Complete the neonatal abstinence syndrome scoring

Complete the neonatal abstinence syndrome scoring
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Neonatal abstinence syndrome (NAS) is the term used to describe the cohort of symptoms associated with drug withdrawal in the neonate.

The Neonatal Abstinence Scoring System evaluates the central nervous system (CNS), metabolic, vasomotor, respiratory, and gastrointestinal disturbances should be the initial step.

This evaluation tool enables the care team to develop an appropriate plan of care. The infant is scored throughout the length of stay and the treatment plan is adjusted accordingly.

Pharmacologic treatment is based on the severity of withdrawal symptoms. Symptoms are determined by using a standard assessment tool.

Medications of choice are morphine, phenobarbital, diazepam, or diluted tincture of opium.

Swaddling, holding, and reducing environmental stimuli are essential in providing care for the infant who is experiencing withdrawal.

These nursing interventions are appropriate for the infant who displays CNS disturbances. Poor feeding is one of the gastrointestinal symptoms common to this client population. Fluid and electrolyte balance must be maintained, and adequate nutrition provided. These infants often have a poor suck reflex and may need to be fed in an alternate way

Which items are appropriate interventions for a newborn with neonatal abstinence syndrome? Select all that apply.

Fewer large feedings to allow for extra rest time
Set up a dim, quiet room and touch slowly
Require all women to formula feed
Provide pacifiers and/or other tools for sucking
Rub back after feedings
Maintain consistent eye contact

Set up a dim, quiet room and touch slowly

Provide pacifiers and/or other tools for sucking

Rub back after feedings
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Rubbing is often better than patting when burping during feedings to avoid triggering Moro reflex.

Vertical rocking facilitates relaxation and eye contact; more soothing than "regular" rocking or side to side.

Avoid eye contact—it can cause overstimulation. Once the infant is recovering, eye contact is typically more tolerable.

Frequent small/demand feedings may help in infants with motor or tone dysregulation.

Breastfeeding is not contraindicated, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with human immunodeficiency virus (HIV).

Nonnutritive sucking helps organize a dysregulated infant and prevents disorganization

The attitude of healthcare providers plays a (pivotal role or a minimal role) in the outcomes of mothers who use drugs and their newborns. Emotional interventions are (less important than or as important as) physical care, such as assessments and medication treatments.

Pivotal role
As important as
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Nurses play a pivotal role in the outcomes of their clients. Nurses who are supportive and nonjudgmental have clients who recover faster, maintain their sobriety, and have a better chance of establishing a positive relationship with their newborns. ​

1 of 6

Which findings require immediate follow-up by the nurse?

Retractions
Spitting up
Body tremors
Uncoordinated sucking
Heart rate of 152

Retractions
Spitting up
Body tremors
Uncoordinated sucking
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Retractions require immediate follow-up. The nurse should also follow up on uncoordinated sucking and spitting up. Body tremors are also of concern as newborns with NAS are at risk for seizures. Heart rate of 152 is a normal finding

2 of 6

Molly may be at risk for (poor feeding or overfeeding) because of her suck coordination and hyperirritability.

Poor feeding
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Poor feeding is associated with excessive sucking, hyperirritability, and vomiting and can put infants at risk for poor weight gain.

Poor feeding is most severe in the initial phase of neonatal abstinence syndrome (NAS), typically lasting for 1 to 2 weeks.

Researchers reported behaviors that disrupted feedings in infants with neonatal abstinence syndrome (NAS) including categories of fussing, resting, crying, and sleeping/sedated.

Infants were found to spend almost twice as much time fussing as feeding. ​

3 of 6

Molly is at the highest risk for (weight loss or respiratory distress).

Weight Loss
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According to the latest nurses' note, Molly is still experiencing poor feeding but respiratory distress appears to have resolved as evidenced by no retractions and normal respiratory rate.

Therefore, Molly is at the highest risk of weight loss due to poor feeding.

The delay in weight gain that results from poor feeding may lead to lengthier hospital stays.

Poor feeding is most severe in the initial phase of neonatal abstinence syndrome (NAS), typically lasting for 1 to 2 weeks.

A healthy newborn is expected to lose 7% to 10% of their birth weight but should regain that weight within the first 2 weeks or so after birth.

There is not an additional risk due to the respiratory rate as it is within the normal parameters.

4 of 6
Select whether each potential nursing action would be
indicated, nonessential or contraindicated.

Discuss feeding frequency
Dim the lights
Ask details about mom's prior drug use
Try to soothe the baby with frequent eye contact

indicated
Discuss feeding frequency
Dim the lights

nonessential
Ask details about mom's prior drug use

contraindicated.
Try to soothe the baby with frequent eye contact
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Teaching the mom about the importance of feeding is essential to help the newborn thrive.

Adjusting the environment to support the feeding is needed.

Asking the mom about her past drug use could help establish a nurse-client relationship, but this isn't the priority right now.

Eye contact would be contraindicated as it could aggravate and stress the newborn even more. As more time passes, the newborn may be able to tolerate some eye contact. ​

5 of 6

Select which actions should be performed immediately.

Order or Nursing Intervention:
Decrease environmental stimuli
Administer methadone as ordered
Provide bath
Feed newborn—breast and then formula 1-2 ounces q 2-3 hours

Decrease environmental stimuli
Administer methadone as ordered
Feed newborn—breast and then formula 1-2 ounces q 2-3 hours
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The priority right now is to focus on the feeding and safety of the newborn.

The environment must be conducive (dim, quiet) to support the feeding.

Medication must be given as ordered to support the weaning process as the goal is to eventually discontinue the methadone.

A bath would be too much stimulation right now and not a priority. ​

6 of 6
or each assessment finding at 15:00, click to specify if it indicates that the infant's condition has improved, not changed, or declined, compared with nurses' notes at 7:00 .

Improved No Change Declined
Newborn breastfed for 10 minutes on each breast
Reduced crying, periods of quiet
Weight 92 oz
Temp 100.3ᵒF/37.9ᵒC

Improved
Newborn breastfed for 10 minutes on each breast
Reduced crying, periods of quiet

No Change
Weight 92 oz

Declined
Temp 100.3ᵒF/37.9ᵒC

The nurse is reviewing the chart of a pregnant client with a known substance use disorder to identify factors that could impact what signs of neonatal abstinence syndrome (NAS) may be present in the newborn after birth. What factors should the nurse consider? Select all that apply.

Type of substance used
Frequency of substance use
Gestational age
Maternal age

Type of substance used
Frequency of substance use
Gestational age
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Signs of neonatal abstinence syndrome (NAS) depend on a variety of factors, such as:

What drug was used during pregnancy (urine, blood, meconium can be tested)​?

How much was used and for how long​?

The gestational age at birth.

Maternal age does not influence the signs of neonatal abstinence syndrome (NAS).​

A pregnant mom, Melonie, is attending a meeting at a community clinic that will provide resources for her during pregnancy. She has been using heroin on and off for two years and reached out for help at her last prenatal appointment. ​Which additional actions are needed for women who are using opioids? Select all that apply.

Supportive nursing staff interactions with clients
Drug treatment and prevention programs
Birth control education
Coordinated weaning process
Increased jail time and convictions
Screening and education of expectant mothers

Supportive nursing staff interactions with clients

Drug treatment and prevention programs

Birth control education

Coordinated weaning process

Screening and education of expectant mothers
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The increasing use of opioid pain relievers and other addictive substances among pregnant women warrants the need for :​

screening and education of expectant mothers​

increased access to follow-up facilities​

early intervention services for high-risk mothers and infants​

drug treatment and prevention programs aimed at improving the health outcomes of mother-infant couplets​

Women should speak to their providers about quitting and a coordinated weaning process should be planned before stopping any medication.

It is not recommended for women to just stop abruptly without support and monitoring. ​

Birth control education is for every pregnant woman, including those with opioid use.

Jail time and convictions have not had a positive impact on mothers and newborns who struggle with substance use.