Neonatal Abstinence Syndrome: Info on symptoms, diagnosis and treatment

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Neonatal Abstinence Syndrome
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Neonatal Abstinence Syndrome

• Neonatal Abstinence Syndrome is a condition
  where babies experience withdrawal symptoms
  following the use of addictive illicit or
  prescription drugs either by the mother or when
  these drugs are prescribed for the baby itself.
  Most commonly, it is due to the use of drugs such
  as opioids, methadone, barbiturates,
  fentanyl, diazepam or other narcotics. There
  are two types of neonatal abstinence syndrome.
  The first type is Prenatal, that is, it occurs
  due to use of drugs by the mother during
  pregnancy. The foetus becomes drug dependant and
  experiences withdrawal symptoms after birth, when
  exposure to the drug is suddenly stopped.  

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Neonatal Abstinence Syndrome
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• The second category is Postnatal which follows
  the use of drugs for the baby in situations like
  emergency mechanical ventilation that requires
  analgesia.
• Fentanyl  is the most common analgesic used in
  newborns It can cause neonatal abstinence
  syndrome if it is suddenly stopped. Drugs which
  are frequently implicated in the occurrence of
  Neonatal Abstinence Syndrome include
  benzodiazepines, opioids, amphetamines,
  barbiturates, heroin, methadone, oxycodone,
  cocaine, marijuana and SSRIs (Selective
  Serotonin Reuptake Inhibitors).

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Symptoms

• It is hard to tell which babies might get
  Neonatal Abstinence Syndrome. Some babies have
  Neonatal abstinence syndrome when a mother takes
  only small amount of drugs while other babies may
  only have Neonatal abstinence syndrome when a
  mother takes large amounts of drugs. Most babies
  born to mothers using drugs develop Neonatal
  abstinence syndrome and signs are usually seen
  within the first few days after birth. Some signs
  of Neonatal abstinence syndrome include 
• High pitched cry
• Tremors/jittering/shaking of arms, legs, face
• Yawning
• Hard time sucking during feeding times
• Poor weight gain
• Fast breathing

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Symptoms
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• Frantic sucking - fists, fingers, thumbs
• Trouble falling asleep and staying asleep
• Fussy - hard to calm
• Sneezing/stuffy nose
• Tense arms, legs and body
• Vomiting/diarrhoea
• Skin rashes - more so in the diaper area and face
• Warm to touch/sweating

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Diagnosis of Neonatal Abstinence Syndrome

• Tests to diagnose Neonatal Abstinence Syndrome
  include 
• Neonatal Abstinence Syndrome scoring
  systems These scoring systems allot point to
  each symptom the baby presents with depending
  upon its severity. The overall score decides the
  necessity for treatment.
• Meconium analysis Meconium is the first stool
  passed by the baby. It is the best method for
  detection of the drug used.
• Urine analysis Urine analysis is also a widely
  used method for detection of drug exposure in the
  newborn, as it contains higher concentrations of
  the drug in comparison with the blood.
• Hair analysis This test is not commonly used as
  it is expensive. But the sample collection is
  very easy and can be done up to 3 months after
  birth.

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Treatments

• Treatment of Neonatal Abstinence Syndrome
  depends upon general condition of the infant,
  severity of the withdrawal symptoms, feeding and
  weight gain issues and pre-term or full term
  baby. Steps to treat infants with neonatal
  abstinence syndrome include
• Frequent, small portions of high calorie formula
  feeds are given for children who present with
  problems of feeding and weight gain. This helps
  with the nutrition of the baby.
• Intravenous fluids are considered in case of
  severe vomiting in a dehydrated infant.Children
  with neonatal abstinence syndrome are often
  irritable and fussy. One can follow these steps
  to calm the baby
• Switching off the lights and keeping a low noise
  or calm environment around them

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Treatments
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• Minimizing handling the baby and use of pacifiers
• Gentle rocking and swaddling also helps
• If these measures do not ease the situation,
  drug therapy would be required. Morphine or
  methadone is commonly used in treating this
  condition. However, the choice drug to be used
  depends on the substance used by the mother
  during her pregnancy.

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