CONSIDERATION ON NEONATAL TOXICITY

Introduction


Misuse of opioids during pregnancy increases the risk of developing symptoms of opioid reliance and withdrawal during child birth, this is called Neonatal Abstinence Syndrome (NAS). They may require extended hospitalization and treatment with tapering doses of morphine to resolve their dependence and control symptoms. (By Stacey C. Tobin, Ph.D., ELS, n.d.)


Epidemiology


The incidence of neonatal abstinence syndrome regarding prenatal opioid usage is growing rapidly over the past few years without any discrimination in different races. It is rapidly growing in the white community as in nonwhite, rural areas and urban too, also seen in public insurance-dependent people. (MacMillan, 2019)


Symptoms


Tremors and muscle rigidity, high pitched and excessive crying, and difficulty in breathing feeding, vomiting, hyperactive reflexes, irritability, poor weight gain, increased sweating, temperature instability, and fever.


Drugs most Commonly Misused


· Pain reliever: Vicodin, Oxycontin, Percocet

· Illicit substances: Heroin

· Opioid maintenance therapy: Methadone, buprenorphine

· Cocaine, Amphetamine, Barbiturates are equally being misused


Challenges in Preventing NAS


Research shows that 50% of all pregnancies in the United States are unintended. Another study in 2019 showed that 7% mothers uses opioid for pain relief. Among them, 1 out of 5 women reported for the misuse of opioids. (“Data and Statistics About Opioid Use During Pregnancy,” n.d.)


Prevention


· In the United States, a state-based database of controlled prescription drugs has been introduced to have a check and balance on prescription drugs dispensed by pharmacies including the details of the patient buying these drugs and the biodata of the prescriber

· Make access to contraception easy both prepregnancy and post-delivery such as Intrauterine devices (IUDs) and Contraceptive implants

· Screening protocols have also been in use to prevent the long-term effects of drug abuse including which women should be screened, what substances should they screen for and when should they be screened

· Child abuse prevention and treatment act: states that women who intentionally put a child's life in danger would be treated harshly in terms of losing custody, parental rights, prosecution fee, and charges and can be arrested too. (Thigpen & Melton, 2014)


Testing and Diagnosis


Tests: different symptoms occur with different substances, also varies when the last time the drug was taken. Symptoms may begin 24 to 48 hours after birth sometimes maybe 5 to 10 days after birth. An accurate report of mothers' drug usage is required for doctors to properly diagnose and treat the baby. There is a scoring system for NAS to grade the severity of withdrawal. This score helps the health provider to plan the treatment and then start it.


Treatment


The medicines to treat severe withdrawal symptoms are given below:

· Methadone for heroin and other opiate withdrawal

· Benzodiazepines for alcohol withdrawal. (Wachman & Werler, 2019)


The doses are gradually decreased to help the body wean off the drug.


Babies also suffer from breathing difficulty and become irritated.to overcome these discomforts following steps should be taken:

· Wrap the baby tightly in a blanket or swaddle also called swaddling or snuggling.

· Sometimes intravenous (IV) fluids are required if the baby becomes dehydrated due to diarrhea or vomiting.

· Give them high-calorie formula because their energy is constantly being wasted by tremors or seizures. (Tricia L. Romesberg, 2017)


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