Neonatal abstinence syndrome (Complete) Flashcards
(13 cards)
Define neonatal abstinence syndrome
Withdrawal syndrome experienced by newborns following exposure to drugs during pregnancy
What drug is most commonly associated with NAS?
Opiods
Give examples of opiods associated with NAS
Heroin
Methadone
Buprenorphine
Give examples of non-opiod substances which can contrubte to withdrawal symptoms.
Benzodiazepines
SSRIs
Nicotine
What are the main risk factors associated with NAS?
Opiod use during pregnancy
Poly-substance drug misuse (e.g. alcohol, , benzodiaepines)
Smoking
Limited antenatal care
Low socioeconomic status
What are the main clincal features of NAS?
Neurological:
High-pitched cry
Hypertonia
Tremors
Seizures
Poor suck reflex or excessive rooting
Irritability
Respiratory:
Tachypnoea
Nasal flaring
Autonomic:
Sweating
Nasal congestion
Yawning
Temperature instability
GI:
Poor feeding
Vomitting
Diarrhoea
Failure to thrive
What differentials should be considerded alongside NAS?
Hypoxic ischaemic encephalopathy:
- Low APGAR scores
- Hypotonia and poor suck reflex vs hypertonia
- Lack of autonomic instability
Sepsis
- Fever and raised inflammatory markers
Neonatal hypoglycaemia
- Jitter + irritable like NAS but lacks autonomic instability
- Low blood glucose
What investigations should be conducted in infants with suspected NAS?
Bedside:
Maternal history for substance abuse
Neonatal examination: Check for hypertonia, poor sucking reflex/excessive rooting,
Meconium or urine toxicogology screen: Check for substances
Finnegan Neonatal Abstinence Scoring System: Assess symptoms severity
Bedside:
CBG: Check for metabolic acidosis, hypoglycaemia
Blood cultures: If sepsis suspected
FBC: Check for infection
CRP: Check for infection
Imaging:
Cranial ultrasound: Rule out differentials
What scoring system is used to assess NAS severity?
Finnegan Neonatal abstinence scoring system
What is the management plan for NAS?
MDT approach (e.g. neonatologists, social workers, substance misuse team, widwives)
Conservative:
Minimise environmental stimuli (e.g. dimly lit rooms)
Skin-to-skin contact
Adequate nutritional suppourt
Encourage breastfeeding (unless mother on illicit drug use)
Medicine:
Morphine or methadone: For opiod dependancy
- Gradually wean off
Phenobarbital: In severe cases or poly-substance exposure
What medication is given in management of NAS due to opiod dependancy?
Morphine or methadone
What medication can be considered in severe cases of NAS or in cases of poly-substance misuse?
Phenobarbital
What complications are associated with NAS?
Increased risk of sudden infant death syndrome
Poor weight gain and failure to thrive
Long-term developmental or behavioural problems
Attachment and bonding difficulties
