Methadone withdrawal

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Specializes in NICU.

So I've got this kid. Mom's been in a methadone program for two years now. He's ten days old, had been weaning with phenobarb, but yesterday they started 0.5mg/kg of morphine because his Finnegans were consistently around 15. Overnight he was getting 7s. I come in, never had the kid before, and I'm adding up to 14, 12, etc. So we increase the morphine from q6h to q4h. Hand to god, the kid gets WORSE. Won't eat (while the previous two feedings he took 35ml), writhing around, red puffy eyes, just miserable. The lowest score I got, half an hour after his last dose, was 6. He's dead asleep, but he's jittery (yes, asleep), tachypneic, congested, flaring, and I know he's got that diaper rash. So the resident, bless her heart, starts giving me static about how she's going to have to write for more morphine if I keep scoring him like this, etc, while she was actually at my bedside one time when I scored him and certainly didn't disagree with anything I found. I, uh, may have asked her if she was asking me to falsely document a low score, but in my defense it was shift change.

So my question, other than how best to hide said resident's body, is what are we missing? Baby gets almost no visitors; mom and dad come in for around five minutes per day and don't touch him, so I spent as much time holding him as I could, but clearly that's not enough. Do any of you use something OTHER than morphine to wean kids off mom's methadone? Clearly just increasing his frequency isn't working.

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Specializes in Community, OB, Nursery.

If it gets really bad - and I mean REALLY bad - our NPs will write for our kids to wean on methadone. It takes longer, but they do so much better. I've also found (maybe you have too) that it sometimes takes about 12-24 hrs between morphine dose change (up or down) and actual behavior change for these kids. Not all the time, and not every kid, but on occasion...

We've got two methadone kids in our 'wellbaby' nursery right now, so I feel your pain. One's 26 days old now and still q4. Mom wasn't even on methadone, she was on suboxone, which is supposed to make the w/d less painful. Didn't work this time.

Is there any reason (nec scare etc.) why the kid can't get sweetease? Do you guys have one of those womb heartbeat simulators that might help him settle. Hang in there. These kids need so much love, and it is so hard to love them sometimes.

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Hi I know this is a bit off topic, but what are Finnigans? here in SA we don't really see that many drug addicted moms/baby's, or rather the private sector where I am we dont.

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Specializes in NICU.
Hi I know this is a bit off topic, but what are Finnigans? here in SA we don't really see that many drug addicted moms/baby's, or rather the private sector where I am we dont.

Withdrawal scale... http://aappolicy.aappublications.org/cgi/content/full/pediatrics;101/6/1079/T4

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Thank you

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Specializes in NICU.

We also will use a "methadone wean" on the babies with a high score. Seems to help most of the time.

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Specializes in Community, OB, Nursery.

I got to thinking about this thread this AM and thought of something else. I noticed your kid had been weaning on phenobarb to start, which I thought was interesting. We usually start our kids on morphine .05mg/kg to begin with...and if they get bad then we add phenobarb. We go to the phenobarb about half the time, the other half kiddo never needs it. I just thought it was interesting that our places do opposite.

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Specializes in NICU, Infection Control.

I googled narcotic w/drawal in neonates and found this article:

http://www.emedicine.com/ped/topic2631.htm#Multimediamedia1

Go ~ 1/2 to 2/3rds down to get to treatment. (The rest is a great review of the whole topic.) Have they done a Phenobarb level recently?

Another tip is to thicken feedings--add 1/2 to 1 tsp of rice cereal to 2 ounces of formula; slows the transit time, they don't get hungry again as fast, and less diarrhea. Ask for simethicone, too.

Tub baths can calm these kids sometimes.

If your hospital has a Pain Service (usually Anesthesia), you could ask for a consult w/them.

Good Luck, and let us know how it goes. I'd much rather have a kid w/draw from straight heroin; it's not pleasant, but it takes waay less time, and once it's over, you're done. Unless the kid has seizures/bleeds, not too much sequelae.

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Specializes in Community, OB, Nursery.

I hadn't thought of a Child Life Specialist, but we have those at our place for hard-to-console kids > 36 weeks. Maybe??

I am interested in this subject because I really try to do right by our methadone kiddos and get so attached to them when they're long-termers (ie. straight from us to kindergarten, or so it seems. record is 90+ days for a methadone kid.)

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We use Methadone for our withdrawal kids. It seems odd and counter intuitive, but they also like to be bundled tightly and put in a vibrating bouncy seat.

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Specializes in NICU.

Siiiiiiiiiigh. So the fellow went to the night nurse last night and tried to get her to contradict my Finnegan. And she told the night charge nurse she had "issues" with how I was assessing my patient. I'm... not happy, let's just say. The attending doesn't seem to have a problem with my scores, and the resident was, you know, THERE when I scored the kid and didn't disagree, but I'ma go have a talk with my CNS this week, because that is so beyond not cool.

Elvish, we start with phenobarb because the working theory on my unit is that giving morphine to a baby who's not intubated will KILL THEM RIGHT NOW OH MY GOD!!!

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Specializes in Community, OB, Nursery.

Elvish, we start with phenobarb because the working theory on my unit is that giving morphine to a baby who's not intubated will KILL THEM RIGHT NOW OH MY GOD!!!

You have got to be kidding me!! Our kids on morphine, we don't even have them on monitors! We are doing RR and temps when we score them anyway, and because they are in there w/ us 24/7 we are always watching them. For Pete's sake.

I can hear your frustration. Hugs to you. I would do exactly what you are doing. You also might want to write something up formally, because you are right - this fellow has got to stop asking you to falsify records AND asking your coworkers to make you look bad. :angryfire

((((elizabells))))

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