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.
Phenobarb is rarely used in our unit, unfortunately. We start with Morphine, then move to methadone to wean. Often, we try to wean with Morphine, but it seems like that fails most of the time and we end up moving to the methadone anyway.
There is a methadone clinic in our area that routinely tells pregnant women there is no withdrawal from methadone and not to worry about taking it. Frustrating.
Another thing that bothers me is some babies do not show active withdrawal until three days or later. By the time they would be treated, they have already been discharged home.
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.
Aghhh!!! I hate hate HATE that!
We all recently had to go to an inservice on how to correctly score a kid. Now I am not kidding. The video they used to enlighten us all had a baby wearing cloth diapers. That's how old it was!
They can't even find a decent video (yes, VHS!) and they're gonna tell me I don't know how to do a Finnigan!
We used to start with PB and then go to methadone if needed. Now using oral morphine and methadone only for the worst of the kiddos. But, as you noted, the scores are very subjective. The saddest thing is most of our withdrawl babies are actually withdrawing from methadone that their mom's get from a clinic where the physicians do not see fit to warn them of the withdrawl baby is going to go through.:angryfire
Ok, so we are not the only ones seeing that prescribers at methadone clinics aren't telling these moms what their babies will go through. That makes me so angry. If I had a nickel for every time a mom told me, "But they said it was safe for the baby!" I would retire in style right now. Grrrrrr.
Ok, so we are not the only ones seeing that prescribers at methadone clinics aren't telling these moms what their babies will go through. That makes me so angry. If I had a nickel for every time a mom told me, "But they said it was safe for the baby!" I would retire in style right now. Grrrrrr.
I wonder if these clinics are just telling the moms what they they think is correct.
I had one w/d mom attempt to start something with me, because my finnigan score sheet was measuing things that normal babies do, like have a diaper rash. I told her that yes, normal babies do have some of those symptoms, but her baby was getting scored for other things, not those, I then showed her the hyperactive moro reflex her baby had and let her attempt to straighten out her babies arm. I also told her that normal newborns aren't jittery. Mom's friend was a pediatric nurse and she looked at our finnigan sheet and told the mom that we weren't scroing her baby right. Mom tried to get in my face over that and I took a deep breath, counted to 5 and asked where her friend worked (a doctors office) and told her that her friend most likely had no experience with finnigan scoring. I wonder if she was a nurse or a medical assitant who is called a nurse.
We have had docs say that they don't believe our scoring either...okay, well you stand here for 12 hours and listen to juniour scream for 12 hours and when you pick him up he is so tight you could probably use him as a basketball! grrrrr.
We get moms that cruise the methadone clinics. I'd rather detox a kid on heroin than methadone.
We aren't allowed to send the kids home on meth, even if the parents are on a program...they tend to steal from their own kids. As for the nursing them, well, most can't be trusted to not be taking something else, so we just don't let any of them. You know the game, one bad egg ruins it for the good ones.
I'm just a first semester nursing student that really wants to be a NICU nurse. I volunteer and sit on the Board of Driectors at a local clinic that provides medical care and social work for women with past or present substance abuse who are pregnant. Basically we provide free prenatal medical care as well as labor and delivery and post-natal care. The doctor that established the clinic and donates her time to these mothers is excellent but I do notice a lot of these mothers are on methadone. My belief is that they come to us to get prenatal care already on methadone (we don't do the drug treatment aspect of their care we just offer a supportive environment and free care) but I'm thinking I'm going to talk to the doctor about why methadone is apparantly the treatment of choice for child-bearing age women when we know what the outcomes are for these babies. Reading this post was quite the education!
I'm thinking I'm going to talk to the doctor about why methadone is apparantly the treatment of choice for child-bearing age women when we know what the outcomes are for these babies. Reading this post was quite the education!
I'm clearly not an addiction specialist or MD but it seems like methadone should be an absolute last option yet I see it being prescribed all the time. I realize that traditional sobriety-based recovery may not be enough to fight some addictions but there are some other drugs on the market like suboxone and tramadol that are suppose to have less severe withdrawal's in neonates. So I'm just curious why methadone still seems to be the gold standard in treatment...
I hear that suboxone is supposed have less severe neonatal withdrawal but we had a kid recently whose mom took that and she still stayed with us for 30+ days. I have, in all fairness, seen more moms on suboxone within the last 6-8mo or so than prior.
prmenrs, RN
4,565 Posts
It's not uncommon for Methadone pts to keep on using Heroin periodically. All the fun, none of the w/drawal.
Editorial comment w/held!!!