A Question for NICU Nurses (especially ones who have been for awhile)

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    I have been watching old episodes of ER for awhile now. I just finished season 4 and for the last several episodes there has been a storyline with an infant who's mother was addicted to heroin, then the baby was put on methadone to handle his withdraw symptoms. The mother was stealing his methadone so Doug Ross decided to sedate him and narcan him to get him off of the methadone, calling it something like "ultra rapid detox."

    Obviously this is far fetched, as nearly all TV medicine is, but it did get me wondering how neonates dependent on opiates are actually handled. I have never heard of a baby on methadone, but I've also never heard of this ultra-rapid detox. I realized I know very little on the topic, so I started researching.

    Most of what I have found is that this is called Neonatal Abstinence Syndrome (NAS) and is treated with small doses of morphine gradually weaned. Is this fairly accurate to what is done? Was there ever a point where infants were discharged on methadone? Is there really such a thing as ultra-rapid detox?
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    We always use Methadone when weaning our opiate-addicted newborns. We would never send them home with Methadone. The weaning process is done totally in-house. I don't think an "ultra rapid detox" is accurate. As soon as the Narcan wears off, the baby will just go back to being addicted. Not to mention, it's just not safe to wean in that manner. When you think of the mechanisms of Narcan, it's used to someone who has had an acute overdose and is respiratorily depressed. That is not the case with addicted babies.

    I would think sedating and giving Narcan would be at cross-purposes, since the point of Narcan is to reverse sedation.
    blondy2061h likes this.
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    Moved to NICU Nursing Forum as better suited to this inquiry

    I concur with klone. On the PEDS Floor, neonates/ infants with NAS are weaned with methadone. They are not sent home until the wean is complete. Most often, Social Services is involved and does a thorough screen on the family (especially the mother). We see quite a few of these infants going home to foster families.
    blondy2061h likes this.
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    Thanks for the replies! I realized that narcan would be contraindicated in a scenario where someone is physically dependent on opiates. It also made no sense to send an infant home on opiates to their heroin addicted mother. That's TV for ya!
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    I'm currently caring for a heroin addicted baby.. We use morphine and slowly wean down based on Finnegan scores. She's been there 3 weeks, and I would guess will be there another week or 2.. Never heard of "ultra rapid detox"..
    blondy2061h likes this.
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    Not to mention that depending on the kid, you could actually cause them to seize by doing that.
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    I have only seen one kid we had to intubate and knock out, and this kid was seizing almost non- stop. We put him on a methadone drip, paralyzed him ( when he wasn't seizing he was off the wall). The mom did heroin, meth and a few other things. One of the saddest things I ever witnessed.
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    Quote from NicuGal
    I have only seen one kid we had to intubate and knock out, and this kid was seizing almost non- stop. We put him on a methadone drip, paralyzed him ( when he wasn't seizing he was off the wall). The mom did heroin, meth and a few other things. One of the saddest things I ever witnessed.
    It wasn't appropriate for me to "like" this. But that is so sad it makes tears come to my eyes.
  12. 2
    Quote from blondy2061h
    I have been watching old episodes of ER for awhile now. I just finished season 4 and for the last several episodes there has been a storyline with an infant who's mother was addicted to heroin, then the baby was put on methadone to handle his withdraw symptoms. The mother was stealing his methadone so Doug Ross decided to sedate him and narcan him to get him off of the methadone, calling it something like "ultra rapid detox."

    Obviously this is far fetched, as nearly all TV medicine is, but it did get me wondering how neonates dependent on opiates are actually handled. I have never heard of a baby on methadone, but I've also never heard of this ultra-rapid detox. I realized I know very little on the topic, so I started researching.

    Most of what I have found is that this is called Neonatal Abstinence Syndrome (NAS) and is treated with small doses of morphine gradually weaned. Is this fairly accurate to what is done? Was there ever a point where infants were discharged on methadone? Is there really such a thing as ultra-rapid detox?
    There is such a thing as rapid detox, or ultra-rapid detox, or whatever you want to call it, but I have never heard of it being used on a baby. The idea is that the practitioner sedates the patient during the detox process so that withdrawal is compressed and the person doesn't feel it. There's not much evidence to support it, but who knows if that's because it actually doesn't work very well or because there just hasn't been enough science yet. Also it's expensive and possibly dangerous.

    Anyway, long story short, it exists, but questionably, and never (from what I've heard) in babies.
    prmenrs and blondy2061h like this.
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    We use Methadone in the NICU, and occasionally phenobarbital. We dose until captured and SS has made their assessment of the home situation. The baby goes home on Methadone, usually with the mother after she is taught how to score and how to dose and signed a contract to attend the regimented outpt clinic once a week. The baby is given just enough medication week to week. It has cut down on LOS considerably. Most places do not have this setup. We are lucky. It has been very successful and only a few parents have "struck out" and had SS called on them. It is a model for other programs.
    blondy2061h likes this.


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