Module 6 Unit C

Question 1

Compare and contrast the ability of urine, mcconium, and hair samples to determine prenatal and pernatal drug use.

Answer 1

Urine will show only current and recent use, and will not detect synthetic drugs, some benzos and designer drugs.

Hair follicles can detect use in the past 90 days.

Meconium in the newborn, if positive, relates to the past 4-5 months.

Question 2

What effect does nicotine have on fetal and newborn growth?

Answer 2

Tobacco exposure is strongly associated with fetal growth restriction and stillbirth in a dose‐dependent relationship.

Question 3

What effect does nicotine exposure have on fetal anomalies?

Answer 3

Cleft lip and palate 
Musculoskeletal defects (clubfoot, craniosynostosis) Gastrointestinal defects (gastroschisis, hernia) 
Asthma and other atopic diseases 
Middle ear infections 
Neurological development deficits 
Sudden Infant Death Syndrome 
Reduced head circumference 
Altered brainstem development 
Cognitive, emotional, and behavioral problems 
Altered lung structure 
Cerebral palsy

Question 4

Do newborns expose to nicotine in utero go through withdrawal through withdrawal?

Answer 4

Yes

Question 5

What type of neural behavior do newborns exposed to nicotine in utero display?

Answer 5

Prenatal exposure to nicotine desensitizes neurotransmitter actions in the fetus. The resulting symptoms of depression, inattention, and hyperactivity in adolescents and adults appear to be partially corrected by nicotine use, suggesting a biologic basis for future smoking addiction.

Question 6

How does nicotine exposure affect newborn cognition?

Answer 6

Delayed or impaired brain development cognitive, emotional,or behavioral problems.

Question 7

What effect does alcohol have on fetal and newborn growth?

Answer 7

Growth deficiency or FGR
CNS dysfunction with developmental disability or brain damage
characteristic facial dimorphisms of short philtrum, thin upper lip, and short distance between the inner and outer eye canthus

Question 8

What effect does alcohol exposure have on fetal anomalies?

Answer 8

CNS dysfunction with developmental disability or brain damage
characteristic facial dimorphisms of short philtrum, thin upper lip, and short distance between the inner and outer eye canthus

Question 9

Do newborns expose to alcohol in utero go through withdrawal?

Answer 9

Yes. Symptoms include high-pitched cry, jitteriness, and seizures.

Question 10

What type of neurobehavior do newborns expose to alcohol in utero display?

Answer 10

Intellectual, behavioral, and learning disabilities and problems with behavior and learning, characterized by academic difficulties with math, memory, attention, judgment, and poor impulse control.

Question 11

How does alcoholic exposure affect newborn cognition?

Answer 11

Intellectual problems
learning disabilities
academic difficulties with math

Question 12

What is fatal alcohol syndrome?

Answer 12

Fetal alcohol syndrome is the most severe effect of drinking during pregnancy. It causes death, abnormalities of the face, growth and central nervous system problems, and learning and mental disabilities.

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Question 13

What is the safe amount of alcohol use in pregnancy or while trying to get pregnant?

Answer 13

Women who are pregnant or trying to get pregnant should avoid the use of alcohol.

Question 14

What effect do opiates (heroin, oxycontin) have on fetal and newborn growth?

Answer 14

Fetal growth restriction, low birth weight

Question 15

What effect does opiate exposure have on fetal anomalies?

Answer 15

Possibly heart defects, neural tube defects, and gastroschisis.

Question 16

Do newborns expose to opioids in utero go through withdrawal?

Answer 16

Yes

Question 17

What type of neurobehaviors do newborns exposed to opioids in utero display?

Answer 17

NAS

Question 18

What effect does marijuana have on fetal and newborn growth?

Answer 18

May affect brain development

Question 19

What effect does marijuana exposure have on fetal anomalies?

Answer 19

None

Question 20

Do newborns expose to marijuana in utero go through withdrawal?

Answer 20

No

Question 21

What type of neuro behavior do newborns exposed to marijuana in utero display?

Answer 21

Deficits in attention span

Question 22

How does marijuana exposure affect newborn cognition?

Answer 22

Attention deficits

Question 23

What effect does methamphetamine have on fetal and newborn growth?

Answer 23

IUGR, SGA

Question 24

What effect does myth amphetamine exposure have on fetal anomalies?

Answer 24

Some isolated defects

Question 25

Do newborns exposed to methamphetamine in utero go through withdrawal?

Answer 25

Yes

Question 26

What type of neural behaviors do newborns expose to methamphetamine in utero display? How does methamphetamine exposure affect newborn cognition?

Answer 26

Neurobehavioral and cognitive defects

Question 27

What is neonatal abstinence syndrome?

Answer 27

The term neonatal abstinence syndrome (NAS) refers to the constellation of signs and symptoms displayed by a neonate exposed to opiates in utero.

Question 28

What substances are associated with neonatal abstinence syndrome?

Answer 28

Opioids

Question 29

What newborn symptoms are suggestive of NAS?

Answer 29

Restlessness, tremors, high‐pitched cry, increased muscle tone, irritability, and exaggerated Moro reflex. Seizures occur in 2–11% of infants withdrawing from opioids if untreated. Sleep pattern disturbance, irritability, and hypertonia may last for 4–6 months

Question 30

What environmental factors help a newborn with NAS?

Answer 30

Keep infant in a quiet and dimly lit room
Handle infant in a soft, slow manner.
Swaddling, pacifiers
Rooming in with mom can be effective in reducing the need for pharmacologic treatment.

Question 31

What drug category are current in NAS algorithms specific for?

Answer 31

Opioids

Question 32

What potential complication can occur when narcan is given to an opioid dependent infant?

Answer 32

Hospitals may have a fear of inadvertently precipitating neonatal withdrawal in infants delivered to previously unrecognized opioid abusers.

Question 33

What drugs does the American Academy of pediatrics consider contra indications to breastfeeding?

Answer 33

Cocaine, illicit opioids, marijuana, methamphetamine

Question 34

What complications are associated with opioid dependence and treatment in pregnancy?

Answer 34

Heart defects, neural tube defects, gastoschisis, IUGR, preterm birth, low birth weight, intrauterine fetal demise

Question 35

When should substance use screening be done and how should patience be screened?

Answer 35

Universal screening for substance abuse allows the healthcare provider to discuss the risks of alcohol, drug, and tobacco use with every pregnant woman, eliminating provider bias in determining who is screened. Early screening at the first prenatal visit enables timely intervention and referral to treatment for pregnant women with a substance use disorder, and maximizes efforts at harm reduction. Screening should be done with a caring and respectful approach using a validated screening instrument.

Question 36

What are available treatment programs for opioid dependence?

Answer 36

Office‐based treatment includes behavioral treatment for substance use with or without medication. For OUD, medication may consist of buprenorphine/naloxone, buprenorphine monotherapy, or naltrexone. Methadone maintenance programs combine behavioral treatment with daily observed treatment with methadone. Intensive outpatient programs (IOPs) offer substance use treatment several days of the week for a standard number of hours on an outpatient basis. Residential treatment programs offer daily, intensive substance use treatment in a residential setting. Some residential programs are gender‐specific. A few residential programs are also equipped to accommodate children whose mothers are seeking treatment.