Neonatal Abstinence Syndrome Flashcards
What is neonatal abstinence syndrome (NAS)?
Neonatal abstinence syndrome (NAS) refers to the withdrawal symptoms that happens in neonates of mothers that used substances in pregnancy. The symptoms and management is slightly different for each substance used in pregnancy. Mothers should be encouraged and supported with cutting back, and if possible stopping, substances that can affect the pregnancy.
What substances can cause NAS?
- Opiates
- Methadone
- Benzodiazepines
- Cocaine
- Amphetamines
- Nicotine or cannabis
- Alcohol
- SSRI antidepressants
When does withdrawal from most opiates, diazepam, SSRIs and alcohol occur?
Withdrawal from most opiates, diazepam, SSRIs and alcohol occurs between 3 – 72 hours after birth.
When does withdrawal from methadone and other benzodiazepines occurs?
Withdrawal from methadone and other benzodiazepines occurs between 24 hours and 21 days.
What are the CNS signs and symptoms of NAS?
- Irritability
- Increased tone
- High pitched cry
- Not settling
- Tremors
- Seizures
What are the vasomotor and respiratory signs and symptoms of NAS?
- Yawning
- Sweating
- Unstable temperature and pyrexia
- Tachypnoea (fast breathing)
What are the metabolic and gastrointestinal signs and symptoms of NAS?
- Poor feeding
- Regurgitation or vomiting
- Hypoglycaemia
- Loose stools with a sore nappy area
Briefly describe the management of NAS
Mothers that are known to use substances should have an alert on their notes so that when they give birth the neonate can have extra monitoring and management of NAS.
Babies are kept in hospital with monitoring on a NAS chart for at least 3 days (48 hours for SSRI antidepressants) to monitor for withdrawal symptoms. A urine sample can be collected from the neonate to test for substances. The neonate should be supported in a quiet and dim environment with gentle handling and comforting.
Medical treatment options for moderate to severe symptoms are:
- Oral morphine sulphate for opiate withdrawal
- Oral phenobarbitone for non-opiate withdrawal
Neonates should be gradually weaned off oral treatment. SSRI withdrawal does not typically require or benefit from medical treatment.
What additional considerations need to be assessed in NAS?
- Testing for hepatitis B and C and HIV
- Safeguarding and social service involvement
- Safety-net advice for readmission if withdrawal signs and symptoms occur
- Follow up from paediatrics, social services, health visitors and the GP
- Support for the mother to stop using substances
- Check the suitability for breastfeeding in mothers with substance use
Briefly describe fetal alcohol syndrome
Alcohol in pregnancy can cross the placenta and enter the fetus, where is disrupts fetal development. There is no safe level of alcohol in pregnancy and mothers are encouraged not to drink alcohol at all, however small amounts are less likely to result in lasting effects. The effects are greatest in the first 3 months of pregnancy.
