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Neonatal Abstinence Syndrome

Topic updated on 11/11/17 11:57pm

Snapshot
  • A two-day old male infant presents with irritability, a high-pitched cry, poor oral intake, and loose stools. He was born at term to a 25-year-old mother with known heroin-use disorder. On exam, the infant is frequently yawing and sneezing. Tremors and hyperactive primitive reflexes are also noted.
Introduction
  • Mother with substance-abuse disorder may lead to acute withdrawal symptoms in the newborn
    • refered to as neonatal abstinence syndrome (NAS)
    • some causes of NAS
      • opioid exposure (most common)
      • nicotine
  • Epidemiology
    • increased incidence of opioid pain reliever use in mothers
      • increases incidence of NAS
  • Pathogenesis
    • opioid withdrawal
      • in utero exposure to opioids due to their lipophilic property and small size
        • crosses placenta and blood-brain barrier
      • birth disrupts drug exposure → withdrawal
Presentation
  • Symptoms
    • irritability
    • poor feeding
    • high-pitched cry
  • Physical symptoms
    • sneezing
    • yawning
    • tremor
    • hyperactive reflexes
    • mottled skin
Evaluation
  • Diagnosis primarily based on symptoms and history of in-utero drug exposure
Differential
  • Neonatal hypoglycemia
  • Neonatal sepsis
  • Intracranial hemorrhage
  • Electrolyte disturbances
    • hypocalcemia
    • hypomagnesemia
Treatment
  • Supportive
    • reduce sensory stimulation
    • nutrition to prevent delayed growth
    • breast feeding
    • skin care
    • IV hydration and electrolyte replacement
  • Pharmacologic
    • opioids
      • based on symptom severity, and responsiveness to supportive treatment
Prognosis, Prevention, and Complications
  • Prognosis
    • low long-term mortality rate
    • adverse neurodevelopmental outcome
  • Prevention
    • avoid maternal opioid use
  • Complications
    • seizures
      • opioid withdrawal presents largest risk of seizure 
    • weight loss


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Qbank (1 Questions)

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(M2.PD.60) You are working in the newborn nursery when a nurse approaches you with a concern about one of her patients. The patient is a 1-day-old full-term child who has not been feeding or sleeping well and has diarrhea. When you examine the child, you note an irritable sweaty baby with a high pitched cry, sneezing, and mottled skin. During your examination, he has a seizure.

Which of the following would you expect to find documented in the patient's chart? Topic Review Topic

1. Maternal smoking during pregnancy
2. In utero exposure to amphetamines
3. In utero exposure to marijuana
4. In utero exposure to cocaine
5. In utero exposure to heroin

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