Management of Neonatal Abstinence Syndrome from Opioids

Grim, Kendra J.; Harrison, Tracy E.; Wilder, Robert T.

doi:10.1016/j.clp.2013.05.004

Cited by 30 publications

(27 citation statements)

References 51 publications

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“…147 Incremental increase or decrease of the dose of morphine depending on the severity of withdrawal is often a common practice. 46,143 Because morphine has short half-life, it must be provided every 3 to 4 hours. Morphine solution is stable and easy to administer.…”

Section: Pharmacological Carementioning

confidence: 99%

“…The pharmacological management of NAS has been a subject of recent reviews. [141][142][143] Opioid antagonists, such as naloxone, are contraindicated because they may precipitate seizures in neonates. Older medications, such as paregoric or tincture of opium, are no longer used or available because they have toxic ingredients and high alcohol content.…”

Section: Pharmacological Carementioning

confidence: 99%

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Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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Section: Pharmacological Carementioning

confidence: 99%

Section: Pharmacological Carementioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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“…From this, they are able to prevent pain, discomfort, lifethreatening complications, and ultimately reduce hospital stay and associated costs. [1,6,7] …”

Section: Limitationsmentioning

confidence: 99%

“…[9,10] The WAT-1 is designed to use data collected from the child's chart, a pre-stimulus observation, a stimulus observation, and the post-stimulus recovery in which the nurse evaluates how long it takes the child to regain a calm state. [6] A score of greater than or equal to 3 on the WAT-1 is indicative of withdrawal and the total score ranges from 0-12. Psychometric properties report concurrent validity as high sensitivity (0.872) and specificity (0.88).…”

Section: Instrument Descriptionmentioning

confidence: 99%

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Determining the reliability of the Withdrawal Assessment Tool-1 in comparison to the Neonatal Drug Withdrawal Scoring System

Hardesty

Letzkus

Miller

et al. 2015

Clinical Nursing Studies

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Background: Children that receive opioids and/or benzodiazepines can develop dependence and demonstrate withdrawal symptoms if the medication is abruptly discontinued. In addition, neonates that are exposed to intrauterine drugs can also manifest symptoms of withdrawal. Due to the limited research, reliability and validity remains unclear among clinical conditions and instruments. Objective: The purpose of this study was to determine the reliability of the Withdrawal Assessment Tool-Version 1 (WAT-1), in comparison to the Lipsitz Neonatal Drug Withdrawal Scoring System (NDWSS). Methods: A prospective cross sectional study was conducted at a University-affiliated academic Children's Hospital. An Advanced Practice Nurse (APN) and a nursing student were trained on the use of both instruments. The student nurse and APN independently filled out both the NDWSS and the WAT-1 based on reports of symptoms and direct observation. Results were analyzed using descriptive statistics and correlations. Results: One hundred assessments were completed. The correlations between the WAT-1 and the NDWSS scores were high (correlation > 0.8 and p < .001). There was a significant difference between the NDWSS scores based on diagnosis (p ≤ .01). Cardiac and neurologic diagnoses tended to score higher when the NDWSS was used. Conclusions: The NDWSS instrument should be used cautiously in children with varying diagnoses especially cardiac and neurological diagnoses.

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Prenatal Drug Exposure

Wallen¹,

Gleason²

2018

Avery's Diseases of the Newborn

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Management of Neonatal Abstinence Syndrome from Opioids

Cited by 30 publications

References 51 publications

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome

Determining the reliability of the Withdrawal Assessment Tool-1 in comparison to the Neonatal Drug Withdrawal Scoring System

Prenatal Drug Exposure

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