giving morphine to neonate without CR monitoring

[nurse296]

Our NICU is starting a new policy that will allow NAS babies to room in with their mother while we are starting and increasing PO Morphine, without CR monioring. My concerns are that we are giving a respiratory depressing medication to a 2,3,4 day old neonate without knowing how it will react. Does anyone else use morphine in this manner?

[meanmaryjean, DNP, RN]

Does Risk Management know about this? I bet they'd be very interested. And why could you not have portable monitors?

[klone, MSN, RN]

I've never worked in a unit where continuous CR monitoring was required for morphine/methadone used for NAS.

[Jolie, BSN]

Frankly, I'd be more concerned about the advisability of mothers caring for withdrawing infants alone in private patient rooms, without immediate supervision and assistance.

We've discussed here the challenges of rooming in for newly delivered women who are often in pain, fatigued, sleep deprived, stressed, etc. Add an irritable, crying baby with feeding difficulties and painful diaper rash, and I believe there is a significant risk of overwhelming mom, perhaps to the point of desperation.

[NicuGal, MSN, RN]

The dose you start with is different than what would be used for pain control or sedation. Our nursery does not routinely monitor these kiddos. Once you reach the upper limit and Ned to add other meds, my guess is that they would be transferred to NICU.

[nurse296]

Our nurse manager feels that we are more liable if we put them on portable monitors without someone to "monitor the monitor". She feels that if the condition warrents monitoring then the baby should be in NICU or SCN.

[adventure_rn, MSN, NP]

I know I'm a little late to the party on this topic, but I guess I'm not entirely surprised; our NAS kids go to peds all of the time without CR monitors, even when they're just a couple of days old (though I've never seen a NICU setup without them).

[Jory, MSN, APRN, CNM]

Frankly, I'd be more concerned about the advisability of mothers caring for withdrawing infants alone in private patient rooms, without immediate supervision and assistance.

We've discussed here the challenges of rooming in for newly delivered women who are often in pain, fatigued, sleep deprived, stressed, etc. Add an irritable, crying baby with feeding difficulties and painful diaper rash, and I believe there is a significant risk of overwhelming mom, perhaps to the point of desperation.

Two of the largest hospitals in my region have private rooms specifically designed for NAS babies and the model is actually growing. There is no evidence that these babies have more adverse outcomes being alone in the room with the mother. Nurse still checks on the baby like any other patient.

[PixieRN1]

I'm glad you pointed this out, previous poster. Hospitals nationwide are actually beginning a slow shift to the model of the rooming in mother” due to some research that has shown reduced usage of meds like methadone and drastically decreased length of stay, not to mention less tangible things like improved maternal-child bonding and an opportunity for staff to observe the mother/infant relationship and provide education for any needs that can and do pop up. This model is showing needed improved outcomes.

As for not trusting the moms with the babies, I think it's better to be in the hospital, moms Providing 24/7 care, and nurses monitoring, so that deficiencies in care can be noted and addressed...and worst case scenario, if neglect happens, CPS can get involved very quickly.

My two cents.

[Pug RN]

All our NAS babies are monitored until they are at a very low dose of diluted morphine and are off any clonidine or phenobarbital they may have needed.

Maybe suggest setting up some monitored rooms so that the babies can still be with mommy but can be monitored as well, or establish a very well documented policy on which NAS babies are OK to room in.