no nicu experience to offer re drug treatment but offering advice from homecare referrals received and care our mom baby program provides.
a. social work referral needed if not already done to assess home situation and preparation for infant.
b. mom would be referred to children and youth protective services re lack of prenatal care and possitive drug
screen in child.
they would check if any problems with mom before, intervene/followup if needed or place child with another person if significant issues.
c. appointment setup for mom for outpt services: pain center and drug counseling --miss appointments and baby not discharged to home.
d. baby kept detained until stable--often 3-6 weeks or more.
e. home care referral for maternal child visit to assess home situation, parental bonding, care followup and
community linkage. 2-3 visits would be done-- they can find the mother.
bowingpur:bowingpur thank you for being an advocate for this child. please kick this situation up the chain of command "to prevent a crtical incident" and suggest this as good education topic for next staff inservice.
from new zewland: nw newborn clinical guideline - drug dependent mothers
infants born to drug dependent mothers
neonatal abstinence syndrome: treatment & medication - emedicine
treatment of withdrawal
- this is managed by the paediatric consultant in conjunction with the registrar and charge midwife and parents. medications are started when the baby has several scores of >8 and after adequate consultation.
- the medication may only be changed by a paediatric consultant or registrar.
- the drug used is neonatal morphine solution 1mg/ml.
- start at 0.5mg/kg/day in 4 divided doses (that is, 6-hourly) and reduce by 10-15% of the original dose every 2-3 days if possible. the infant may need increasing doses for stabilisation in the first few days.
- medication must be given strictly as charted given directly into baby's mouth by syringe. the drug must be given by a registered nurse/midwife who checks the drug - not a parent.
- medication times are not to be changed to fit in with baby's feeds times. this interferes with the withdrawal regime. do not draw up milk into the syringe because dead space can lead to overdose of morphine.
- if the medication time falls between feeds it is not necessary to wake the infant completely. it has been noted on past experience that babies take the medication well if the syringe is slipped into the mouth and medication is taken without any problems. the baby is then tucked back to sleep.
- it is always a help if identification is on the left as this disturbs the baby less when noting identification.
- an alternative treatment is chlorpromazine 2.2mg/kg/24 hours given in four divided doses either orally or by injection. full dosage should be given for two to four days then tried to decrease at two day intervals if baby's condition, according to the clinical score, permits.
medications should be considered when supportive measures fail to ameliorate the infant's withdrawal. this may be manifested early on as difficulty with feeding, extreme irritability, and poor sleeping. if a scoring system is used, pharmacological treatment is commonly started when the average of 3 scores is 8 or more on the finnegan scale[color=#006699]6
or 4 or more on the lipsitz scale.
many pharmacological agents have been used to treat neonatal abstinence syndrome (nas). however, few randomized trials have compared the efficacy of the various pharmacological treatments. a recent us survey reported that opioid medications are the most commonly used medications for the treatment of both opioid and polydrug withdrawal.[color=#006699]9
diluted tincture of opium (dto) is recommended by the american academy of pediatrics for the treatment of nas due to opioid withdrawal.[color=#006699]10
many neonatal units use proprietary oral or intravenous morphine solutions, and methadone is also used.
currently, many infants are exposed to polydrug abuse. unfortunately, evidence from randomized studies is insufficient to determine the best management for these patients. in 2 randomized trials, phenobarbital, rather than diazepam or paregoric, was best at controlling symptoms in infants exposed to polydrugs. the results of another study suggested that the combination of phenobarbital with dto may be more effective than dto alone because the combination was associated with a shorter hospital stay.[color=#006699]8
journal of infusion nursing:volume 28(3)may/june 2005p 159-167 identification and management of neonatal abstinence syndrome
advances in neonatal care - fulltext: public health nursing ...
home intervention for in utero drug-exposed infants
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