Class 10. Infants of Substance Using Mothers (ISUM)

Question 1

Heroin

Answer 1

Cons for MOM:
chaotic lifestyle,
increase risk miscarriage, still birth, placental abruption
increase BP,
IV drug use risks for HepB/C/HIV;
decrease prenatal care,
poor nutrition,
more likely to engage in risky behaviours
-higher risk of death

pros for mom:
none
—————————
Cons for baby:
-smaller head circumference
-LBW
-risk of premature delivery
-developmental delays
NAS!!! (opioids)
increase risk of SIDS

pros for baby:
-unlikely teratogenic

Question 2

Methadone

Answer 2

Pros for MOM:

-not as many highs and lows
-more stability
-safe supply, done by professional
-transition to methadone from heroin is regulated by HCP = they might also get prenatal care, increased access to services and monitoring

cons for mom:
-withdrawal
———————–

Pros for baby:

-increased head circumference, increased BW, decreased mortality

Cons:
-increased NAS symptoms
-increase hospital stay
-risk for SIDS higher than wih heroin

Question 3

^Short anwser out of 4 marks

Question 4

readiness for Discharge

Answer 4

3 categories of care for NAS

-PHARMA - morphine PO syringe
-tapered
-doses based on NAS scoring

-FEEDING
-increased frequency but short, smaller feeds dt poor suck and vomiting.
-add extra calories to feeds
-BF not recommended if HIV positive. ok if they smoke, drink less 2 drinks

SUPPORTIVE CARE
-swaddling
-decrease stim, noise, dark room
-massage

Criteria for discharge:

*Psychological status: infant is showing neurologically on par with infant same aage that is not detoxing, stable

*Baby hasn’t required Morphine for 5 days

*Baby tolerating oral feeds & gaining weight

*teaching done

*Follow up is set up - MCFS/HCP within 24 hrs by nurse, 48 hrs by doc, followed by public health nurse. (know community follow up)

*Mom’s capability to care at home & home environment that matches what baby needs to settle

Question 5

3 situations that warrent pharm use of Morphine in NAS infant:

Answer 5

-Convulsions
-inconsolable cry for 3 hrs
-persistent tremors,
-persistent/ projectile vomiting

• start morphine

Question 6

Drug used to stabilize pt with heroin

Answer 6

methadone

Question 7

Polydrug

Answer 7

Stimulants:
speed
cocaine
methamphetamine (crystal meth)

Opioids:
heroin
codeine
methadone

Question 8

When do drugs do most harm

Answer 8

First semester: organogenesis and brain growth (before 10 wk)

Early preg signs can be easily missed

second & third trimester: neonates can dev addictions and dependencies to different substances.
-mothers encouraged not to quit cold turkey as it is not safe for the child
-mothers stabilized w/ methadone

Question 9

Cocaine/crack

Answer 9

cocaine bought on street is 10-15% pure, effects developing CNS

-(highlighted) no recognized pattern of predictable neonatal withdrawal symptoms
vs predictable withdrawal symptoms w/ opioids

Question 10

Opioids -
heroin is fast,
methadone is oral, slower onset, fewer high/lows

Answer 10

pros cons to mom and baby at top

-do not stop using abruptly during pregnancy
-methadone maintenance or weaning with HCP support

Question 11

Neonatal urine drug screening

Answer 11

collect asap after birth

screening requires mother consent

Question 12

Neonatal urine drug screening

Answer 12

collect asap after birth

screening requires mother consent

Question 13

Neonatal
Abstinence
Syndrome

(NAS)

Narcotic withdrawal signs

Answer 13

drugs pass to baby from the placenta

Neonatal withdrawals:

W wakefulness
I irritability
Tx2 tremors, tachypnea
Hx2 hyperactivity, high pitch cry
Dx3 diarrhea, disorganized suck, diff to console
Rx3 resp distress, rhinorrhea, rub marks
A apnea
W wt loss or FTT
A autonomic (sweats, fever)
L lacrimation
Sx2 sneezing, seizures

Question 14

Tx for NAS

Answer 14

Pharmacological:
when to start morphine:
-convulsions
-inconsolable crying for 3 hours
-persistent projectile vomiting

-give morphine at regular intervals
-score q3h

-taper dose until stable (decrease in symps and gaining wt)

Feeding:
-small freq feeds

Supportive Care:
-swaddling
-dim lights, reduce noise
-massage, pacifier

Question 15

Discharge criteria

readiness for discharge

KNOW FOR SHORT ANSWER

Answer 15

Criteria for discharge:

1.Psychological status: infant is showing neurologically on par with infant same age that is not detoxing, stable

2. Baby hasn’t required Morphine for 5 days
3. Baby tolerating oral feeds & gaining weight over 3-5 days
4. teaching done
5. Follow up is set up - MCFS/HCP within 24 hrs by nurse, 48 hrs by doc, followed by public health nurse. (know community follow up)
6. Mom’s capability to care at home & home environment that matches what baby needs to settle