Flashcards in Neonatal Abstinence Syndrome Deck (116)
How many babies are born each year with NAS from non-iatrogenic causes?
What is the trend of associated hospital costs with NAS treatment?
increased from $190 million in 2000 to $720 million in 2009
What is the trend of women using opioids during pregnancy?
5 fold increase
What is the trend of babies diagnosed with NAS?
3 fold increase
What is the range of reported LOS a/w NAS treatment?
8-79 days with an average of 30 days
Why does LOS vary among patients?
bc optimal treatment has not been identified
What percentage of NAS babies will require pharmacologic mgmt?
What medications are a/w NAS?
opioids (heroin, methadone, fentanyl, ms, demerol & oxycontin) and non opioid depressants that may present with some or mimic symptoms of NAS (benzos, antidepressants, barbiturates, anticonvulsants, antipsychotics and alcohol)
What are some crucial properties of heroin?
20-25x stronger than MS; very addictive; enters fetal tissue within 1h after maternal consumption
What are some crucial properties of methadone?
substitute for heroin, detected in fetal brain 1-2h post ingestion and the metabolite present in urine up to 5d
What are some crucial properties of buprenorohine/ subutex?
similar to methadone, better outcomes and less likely to relapse, easily tapered for detox, approved for use with non-pregnant women
Why is subutex a/w better outcomes?
partial buprenorphine agonist so does not bind sa readily to the buprenorphine opioid receptors and therefore, better outcomes
What was the difference in peak NAS scores in infants of mothers treated with subutex as compared with methadone?
What was the difference in treatment needs in infants of mothers treated with subutex as compared with methadone?
% of neonates needing treatment was not significantly different
What does anecdotal evidence suggest about the severity of withdrawal symptoms in infants born to mothers treated with subutex?
What was the difference in LOS for infants of mothers treated with subutex as compared with methadone?
43% less time in the hospital- 10 days vs 17.5 days
What was the difference in morphine treatment needs in infants of mothers treated with subutex as compared with methadone?
89% less treatment with morphine- mean total dose 1.1 mg v 10.4mg
How are barbiturates and alcohol similar?
both depressants, cross the placenta readily, addictive and produces withdrawal symptoms
How is fetal alcohol spectrum disorder criteria ranked?
criteria are ranked from 1 (normal) to 4 (significant FAS)
What are some crucial properties of marijuana?
addictive element is delta 9 tetrahydrocannabinol, crosses the placenta, fat soluble and can be detected in the infant's urine on the 1st sol and stool until dol 3
What are some crucial properties of PCP?
synthetic drug- hallucinogenic, extremely lipophillic; metabolites found in infant urine for 1-7d after MOB stopped using 3 months prior to delivery
What are common s/s of withdrawal with alcohol?
D, V, poor feeding, sweating, tachypnea, irritability, tremors, high pitched cry, sz, hypertonicity
What are common s/s of withdrawal with marijuana?
irritability and disturbed sleep; no recent studies looking at marijuana use in pregnancy that isn't confounded by other drugs
What are common s/s of withdrawal with barbiturates?
sneezing, irritability, restlessness, tremors, disturbed sleep, increased crying and convulsions
What are some crucial properties of cocaine?
powerful CNS stimulant, crosses the placenta, metabolite present in urine (1-2d) and stool (>7d), half life ~ 60 +/- 30 min in adult, 6-8h in infants; powerful vasoconstrictor (may result in structural defects r/t insufficient blood supply)
How does cocaine affect with synaptic cleft?
norepi is not reabsorbed in the synaptic cleft and interferes with serotoninon and dopamine receptors
What are some crucial properties of methamphetamines?
highly addictive form of amphetamine; stimulant like cocaine; man-made where cocaine is plant-derived; damages neurons that produce serotonin and dopamine
What is the common withdrawal sign from stimulants?
What are common s/s of withdrawal with PCP?
sneezing, D, V, poor feeding, fist sucking, irritability and increased crying