[NurseRoRo]

why are most babies on methadone weans in the NICU? i used to work in peds rehab and remember getting lots of NICU grads who came to us for narcotic wean as well as parent training, feeding, etc.

[Finallyat40]

to be on a methadone wean, some of them might include:
1) Mom was a drug addict (methadone is used alot for heroin dependent infants)and infant needs to be detoxed
2) Infant was on fentanyl/versed for an extended period of time and they need to be weaned slowly

We use po methadone, but also NOS and ativan when needed. These weans are very slow and in our unit all babies on a wean are given a withdrawal score every 6-8 hours to determine if they should continue to be weaned or need to settle in.

Does that help?

Jamie

[Gompers]

Originally Posted by NurseRoRo

why are most babies on methadone weans in the NICU? i used to work in peds rehab and remember getting lots of NICU grads who came to us for narcotic wean as well as parent training, feeding, etc.

Finallyat40 is exactly right - those are the two reasons a baby might be on methadone in the first place. But I wouldn't go as far as to say that "most" babies in the NICU are on it! Very very few, usually. A typical preemie or surgical case usually isn't sick and vented long enough to become narcotic addicted enough to require methadone. Most of the time we're able to wean them down on their current narcotics - usually morphine and fentanyl - and monitor their withdraw. I've only ever seen a handful of kids get methadone and they were either the babies of methadone moms or really really chronic babies with lots of surgical issues.

[NurseRoRo]

thanks for the input. i now work in the operating room and we do surgeries on adults as well as neonates. the hospital just started doing neonate surgeries, and of course we have lots of nurses who are freaked out about doing surgeries on babies (the whole i'm an adult nurse, not a baby nurse attitude). whenever one of our nurses gets report about a NICU baby who's on methadone, everyone sighs and goes "oh geez. another baby who's addicted thanks to mom. they've got so many other problems and drug addiction shouldn't be another one, too...it's so sad...blah, blah"

i have tried to tell them that just because a baby's on methadone, it's not just because of in-utero addiction. unfortunately, i didn't have any other plausable reason, other than long term ventilation/paralyzation/sedation. then i got the "but why do the even use methadone or morphine...we don't use those drugs when we sedate/paralyze our patients in the OR?" can you say, i had a big brain fart and no response???

so...thank you thank you! it's hard to be the newest staff person (and the youngest with the least amount of OR experience) to educate others who are set in their ways. but luckily, i get to do most of the baby cases based on my background (my whole nursing career has been peds and peds rehab) i know i wasn't crazy or delusional when we got admissions for narcotic weans from the NICU. i know not every parent was a druggie!!!

[Gompers]

Originally Posted by NurseRoRo

thanks for the input. i now work in the operating room and we do surgeries on adults as well as neonates. the hospital just started doing neonate surgeries, and of course we have lots of nurses who are freaked out about doing surgeries on babies (the whole i'm an adult nurse, not a baby nurse attitude). whenever one of our nurses gets report about a NICU baby who's on methadone, everyone sighs and goes "oh geez. another baby who's addicted thanks to mom. they've got so many other problems and drug addiction shouldn't be another one, too...it's so sad...blah, blah"

i have tried to tell them that just because a baby's on methadone, it's not just because of in-utero addiction. unfortunately, i didn't have any other plausable reason, other than long term ventilation/paralyzation/sedation. then i got the "but why do the even use methadone or morphine...we don't use those drugs when we sedate/paralyze our patients in the OR?" can you say, i had a big brain fart and no response???

so...thank you thank you! it's hard to be the newest staff person (and the youngest with the least amount of OR experience) to educate others who are set in their ways. but luckily, i get to do most of the baby cases based on my background (my whole nursing career has been peds and peds rehab) i know i wasn't crazy or delusional when we got admissions for narcotic weans from the NICU. i know not every parent was a druggie!!!

Thanks for the info!

Honestly, any NICU grad that is having surgery and is on methadone is probably on it because WE got them addicted to narcotics, NOT mom. Babies born to moms that are on heroin and methadone don't typically have problems that require surgery, unless of course something happens to them in the NICU. Usually it's a baby that is either surgical or otherwise very sick at full term, and we've got them on narcotics for so long, and in such high doses as they become toleratant, that by the time they're WELL we've got a little bit of an addict on our hands, unfortunately. Many NICUs have pain teams or committees that put out guidelines for things like increasing the pain med every few days so the baby still gets pain relief and sedation as they grow more and more tolerant to the medications.

I've had a lot of people ask me why we use so much IV narcotics on these babies when in the OR they don't use that stuff. Difference: GAS. We don't use anesthesia gasses on young babies, especially preemies. When they have surgery, they get things like pancromium for paralyzation, fentanyl for pain, versed for sedation, etc. We even do surgery IN the NICU for kids too unstable to go to the OR. So that's a big difference between neonatal surgery and adult surgery. After they're full term, I believe gas is okay for them, but I could be wrong.

So yes, if you guys get a baby that is addicted to narcotics post-NICU and also has surgical problems, it's most likely NOT the mom's fault! It's OURS!

[Finallyat40]

very few on methadone due to maternal addiction, as long as those kids are term, they are managed for their methadone wean in the newborn nursery. The only ones we see are the ones that are pre-term....and typically these moms (if targeted early enough in clinic) are put on the ante-partum floor and managed there until the babe is term, then they are managed in newborn, detoxed and many go home with CPS involvement.

[fergus51]

Also don't forget some moms are on pain meds for legitimate reasons (we've had moms with sickle cell for instance who used narcotics). It isn't always illegal drugs that they are using.