A specialized diet, baby swings and a group of trained volunteer cuddlers are also key to soothing babies with NAS. If withdrawal symptoms are severe enough, doctors and nurses will administer small amounts of oral morphine based on the severity of the symptoms.
- Room in with your baby. ...
- Give your baby skin-to-skin care (also called kangaroo care). ...
- Be gentle with your baby. ...
- Swaddle your baby (wrap him snuggly) in a blanket.
- Keep your baby's room quiet and the lights dim.
- Breastfeed your baby. ...
- Give your baby a pacifier.
What is the standard of care for newborns with Nas?
The standard of care for newborns with NAS includes an environment that supports physiologic stability by offering comforting interventions such as holding, swaddling, and decreasing excessive stimulation. Infants who don’t respond to this care may require pharmacologic treatment, most commonly with morphine or methadone.
What is the best treatment for neonatal abstinence syndrome (NAS)?
Standardized care and compassion are key to successful treatment. Evidence-based standardized protocols are needed to provide the best treatment for the mother-infant dyad and improve outcomes for infants neonatal abstinence syndrome (NAS) and mothers with substance use disorders.
What happens to newborns in the NICU?
If the newborns met the threshold for NAS, they were transferred to the neonatal intensive care unit (NICU). They were separated from their mothers and treated with medication in a hectic environment punctuated by the sounds of beeping monitors, busy clinicians, and cries from other infants.
What is the Eat Sleep console approach for neonatal abstinence syndrome (NAS)?
Eat, sleep, console approach: A family-centered model for the treatment of neonatal abstinence syndrome. Adv Neonatal Care. 2019;19 (2):138-44. Grossman MR, Berkwitt AK, Osborn RR, et al.
How long do babies with NAS stay in NICU?
When can my baby leave the hospital? Babies who do not need medicine to control NAS may stay in the hospital for up to a week. Many babies who need medicine for NAS stay in the hospital up to three to four weeks and rarely some may stay longer. It all depends on how your baby responds to treatment.
How do you take care of a NAS baby?
How can I comfort my baby if they have NAS?Hold your baby skin to skin.Keep the lights low and the room quiet.Don't wake the baby up when they are sleeping unless they need to eat.Wrap the baby tight using a blanket or sleep sack so they feel safe.If the baby is fussy, rock them and talk to them in a soft voice.More items...•
How long does it take to recover from NAS?
Symptoms related to NAS can last from one week to six months. Most frequently babies are hospitalized for two to four weeks.
How long does a baby go through withdrawal?
You may hear newborn withdrawal referred to as neonatal abstinence syndrome or NAS. Symptoms usually appear 1 to 7 days after birth. Symptoms can be mild or severe, but they usually go away by the time a baby is 6 months old.
Do NAS babies sleep a lot?
Babies with NAS are sometimes born too early (premature) and often are smaller than other babies. They usually start to show signs of withdrawal a few days after birth. They may be fussy, irritable, or cry a lot, usually with a high-pitched cry. Many babies have trouble sleeping, eating, and gaining weight.
Does breastfeeding help with NAS?
Reducing the symptoms of NAS through non-pharmacologic treatments can reduce both the length of hospital stay and financial cost for mothers. Furthermore, breastfeeding strengthens the mother-infant dyad and contributes to the reduction of NAS duration and severity.
What are long term consequences of NAS?
The most common long-term side effects of neonatal abstinence syndrome include: Low birth weight, less than 5 pounds 8 ounces. Newborn jaundice, or the yellowing of a baby's skin and white areas of the eyes. Seizures.
How long should a NAS last?
NAS can last from one week to a few months.
What is a good NAS score?
The Finnegan Neonatal Abstinence Scoring System17 The individual NAS symptoms are weighted (numerically scoring 1–5) depending on the symptom, and the severity of the symptom expressed. Infants scoring an 8 or greater are recommended to receive pharmacologic therapy.
How do you know if a baby is born addicted to drugs?
Babies born to substance-abusing mothers may have short- or long-term effects. Short-term withdrawal symptoms may consist only of mild fussiness. More severe symptoms may include acting irritable or jittery, feeding problems, and diarrhea. Symptoms vary depending on which substances were used.
Why do withdrawing babies sneeze?
Primarily, newborns sneeze a lot because they have to. Newborns have smaller nasal passages than adults and may have to literally clear their noses more often than adults do, since they can get clogged more easily. They sneeze to get rid of anything from breast milk to mucus, smoke, and even dust bunnies in the air.
What drugs cause NAS?
NAS may occur when a pregnant woman takes drugs such as heroin, codeine, oxycodone (Oxycontin), methadone, or buprenorphine. These and other substances pass through the placenta that connects the baby to its mother in the womb. The baby becomes dependent on the drug along with the mother.
What is the standard of care for a newborn with NAS?
Infants with NAS who require hospitalization traditionally have been admitted to special care nurseries or the neonatal intensive care unit (NICU).
Why is it so frustrating for nurses to care for infants with NAS?
Nurse distress and frustration when caring for infants with NAS frequently is linked to lack of knowledge and understanding about mental illness and substance use, as well as the accompanying social complexities (poverty, homelessness, and trauma). Organizations should offer education that helps nurses build trusting partnerships with mothers with mothers affected by substance use disorder.
How many cases of NAS in 2014?
According to Winkelman and colleagues, NAS incidence has quadrupled within the last decade; as of 2014, the incidence was approximately 14.4 cases per 1,000 births. More recent reports indicate that the incidence ...
Why is NAS care varies?
Care of infants with NAS varies widely because no consensus exists on the best diagnostic or treatment strategy. Variations in care and using a subjective, rather than objective, scoring tool increase the potential for unnecessary exposure to pharmacologic treatment. Lack of standardization, inconsistent care plans, and pharmacologic treatment are associated with longer lengths of stay, unnecessary separation of the mother and infant, and poor long-term developmental outcomes. Evidence of improved outcomes supports local improvement efforts that focus on standardizing care. (See Follow a standard .)
What is the best treatment for a newborn who doesn't respond to morphine?
Infants who don’t respond to this care may require pharmacologic treatment , most commonly with morphine or methadone. Pharmacologic intervention is associated with significantly longer lengths of stay, increased hospital stay costs, and the potential for mother and baby separation.
What is Finnegan NAS?
The Finnegan NAS scoring system , developed in 1975, is the seminal and most common tool used to guide pharmacologic NAS treatment. Nurses evaluate infants every 1 to 4 hours, based on their age, and score them on the presence and severity of common withdrawal signs, including central nervous system, metabolic vasomotor, respiratory, and GI disturbances. Pharmacologic treatment is recommended for any infant who receives a score ≥ 8 on three consecutive evaluations.
How often does a newborn get NAS?
Throughout the United States, at least one newborn is affected by NAS every 15 minutes. The standard of care for newborns with NAS includes an environment that supports physiologic stability by offering comforting interventions such as holding, swaddling, and decreasing excessive stimulation.
What does NICU do?
NAS may be a tough subject for parents, so the NICU works with the Children's Hospital Social Work Department and the Department of Children’s Services if needed. The hospital sets up follow-up care and safeguards for when babies return home.
How does Children's Hospital help babies?
Children's Hospital accomplishes this by keeping babies swaddled in private rooms. The rooms are kept quiet and dark, avoiding overstimulation. A specialized diet, baby swings and a group of trained volunteer cuddlers are also key to soothing babies with NAS.
What happens to babies after birth?
After birth, they experience withdrawal just like adults. They have a screech-like cry, claw their faces and squirm. The withdrawal process is very painful. Babies can become dependent on: Children's Hospital developed a special treatment protocol for babies with Neonatal Abstinence Syndrome (NAS).
What is optimal nursing care for NAS?
The literature suggests that optimal nursing care provided to infants experiencing NAS and their families is often provided by cohorts of nurses who develop specific expertise relative to the needs of the NAS infant.2 This allows the nurse to further develop their assessment skills, establish the highest levels of interrater reliability in the withdrawal assessment scale, and establish a depth of expertise in working with parents who have specific educational and care needs that are unique to the NAS infant. For this reason, neonates in the NICU at BWH with NAS should be preferentially admitted to the Growth and Development Unit. Additionally, under optimal circumstances, infants with NAS will be cared for by a nurse with no more than a 2:1 staffing ratio.
How often does abstinence occur in a newborn?
Scoring of babies deemed to be at risk of neonatal abstinence syndrome will begin after arrival to the nursery and occur every 3-4 hours utilizing the Modified Finnegan Neonatal Abstinence Scoring Tool (Appendix 2). Scores should reflect the entire 3-4 hour period considering the normal infant sleep-wake cycle.
What is neonatology antenatal consultation?
All pregnant women who screen positive at any time during their pregnancy or at birth will be referred to the Neonatology Antenatal Consultation Service. At their consultation, mothers will be educated regarding Neonatal Abstinence Syndrome by the physician and given an informational brochure. The State Protection and Care of Children Act (51A) is described in the informational brochure and will be discussed at the antenatal consultation. The Neonatology Antenatal Consultation Service will ensure that social work is involved prenatally. The Neonatology Antenatal Consultation Service will collaborate with a clinical pharmacist for questions regarding specific medications in relation to expected course of neonatal abstinence or breastfeeding. Breastfeeding recommendations will be reviewed on a case by case basis and discussed with the mother during the prenatal visit. Antenatal discussions will be documented in the consult note.
Recent NAS studies
A recent study published in Pediatric Medscapes by Dr. William T. Basco looked at using methadone treatment compared with morphine to shorten length of stay. Statistics from the study were eye opening:
Collaborative efforts to improve NAS healthcare
So, what is being done, or what can we do as clinicians to help with this growing problem?
Maryland offers a solution
A very promising solution also comes from the state of Maryland, which also launched a NAS collaborative to look at improving outcomes. The Maryland Patient Safety Center developed best practices to focus on improving care of infants with NAS.
About the Author
Kathleen Quellen, RN, BSN, has been a NICU/PICU RN since 1981. She has worked in hospitals all over the U.S., including Georgetown University Hospital, DC Children’s, Cedars Sinai and Children’s Hospital of NJ. She worked as a Clinical Specialist for Abbott Labs/Hospira and has been a NICU Clinical Specialist for Medela LLC since 2014.
What is the best treatment for NAS?
Traditionally, treatment has included medication such as methadone or morphine for babies with moderate to severe NAS signs. However, more recent data reported in Pediatrics point to the benefits of nonpharmacologic approaches, including breastfeeding when appropriate and physical touch by caregivers.
What are the signs of NAS?
Common signs of NAS include tremors, poor feeding, breathing problems, and fever.
Is MGH launching a new clinic?
In fact, MGH is launching a new clinic designed partly to meet needs these women often face after delivery, explains Sarah Wakeman, MD, medical director for the Substance Use Disorders Initiative at MGH and assistant professor of medicine at Harvard Medical School.
Clinical Effects
Diagnosis
- Diagnosing an infant with NAS requires an accurate history of the mother’s drug use (including the last drug used and the time of consumption) and evidence of withdrawal. A scoring system can be used to aid diagnosis. Points are assigned based on the severity of each sign, and the total score helps determine the treatment plan. No strong evidence exists that one scoring tool is sup…
Treatment
- The standard of care for infants with NAS, first described in the 1970s, includes holding, nonnutritive sucking, swaddling, pressure, rubbing, swaying, rocking, and reducing external stimulation. Infants with NAS who require hospitalization traditionally have been admitted to special care nurseries or the neonatal intensive care unit (NICU). For ba...
Challenges
- Nurses encounter many challenges when considering appropriate evaluation, diagnosis, and treatment for infants with NAS.
Nursing Implications
- Studies have identified the benefit of prenatal care screening and early intervention, but barriers to care may mean that NICU and other nurses are the first sustained contact that mothers of infants with NAS have with the healthcare system. Nurses have an opportunity to encourage and facilitate integrated, comprehensive, multidisciplinary care; establish trust; empathize with mothers to inc…
Foster Respect and Compassion
- Providing standardized care for infants with NAS must be accompanied by equal care and support of the mother. Fostering a respectful and compassionate environment and establishing a nonjudgmental, trusting relationship with mothers will help them learn to interpret and manage signs of NAS in their infants. Nursing assessment and critical thinking skills are instrumental to …
References
- Alexander K. Social determinants of methadone in pregnancy: Violence, social capital, and mental health. Issues Ment Health Nurs. 2013;34(10):747-51. Bagley SM, Wachman EM, Holland E, Brogly SB. Review of the assessment and management of neonatal abstinence syndrome. Addict Sci Clin Pract. 2014;9(1):19. Child Welfare Information Gateway. What is child welfare? A guide for educ…