Narcan administration in newborns

[jennf83]

Quick question for you experienced OB nurses. I have never had to give Narcan to a newborn following birth, but how do you know when you are to do it, I know the "obvious" reason, but how do you know for sure its from mom getting a narcotic close to delivery or something more serious going on in the baby.

[RNBelle]

Did mom get a narcotic within an hour prior to delivery? If she did and your baby is kind of "poopy" then you can rationalize that it is from the narcotic and you can give him the narcan. Now if mom has had a completely natural childbirth with no medication interventions you may have to assume something else. Remember to follow your NRP guidelines and call for help if you need it.

[SmilingBluEyes]

Remember, Narcan is short acting. Our babies must be observed in the special care nursery no less than 4 hours after Narcan is given for that reason. A baby can respond to Narcan and then be in trouble again a few minutes later. I have not had to give Narcan in over 10 years.

[jennf83]

Thanks everyone! So in other words, you dont really want to jump for the narcan right away, you wanna just follow nrp guidelines first?

[Elvish, BSN, DNP, RN, NP]

Absolutely, you want to follow NRP in every case. Also, keep in mind that giving it to a baby whose mom has a hx of drug use can cause immediate withdrawal (which is obviously bad). I'd be very very cautious. Personally, I have given it once and can count on one hand the number of times I've seen others give it.

[NurseNora, BSN, RN]

Haven't used it in years. Used to use it more often back in the 70s, but we used Demerol 50 mg then. Now we usually use Stadol or Nubain; shorter acting and both are agonist/antagonists.

Back in the old days, it was part of our standing orders to give Narcan to depressed babies, but now we would have to call the Peds for an order first. So the Doc would think of all the other possible reasons for the depression and ask about them before giving the order to use it. So it's not all on your shoulders to decide whether or not to use it.

The problem with it is that it can wear off before the narcotic it is counteracting wears off. That's why the babies who get it need to remain under close observation for some period of time.

[SmilingBluEyes]

Elvish brings up a huge and important point. I always entreat moms to be honest if drug use is strongly suspected, because if they use a lot of opioids and we use Narcan , we can do a LOT of damage.

[EricJRN, MSN, RN]

NRP says that both of the following must be present in order for nalaxone to be indicated:

- Continued respiratory depression after positive-pressure ventilation has restored a normal heart rate and color.

AND

- A history of maternal narcotic administration within 4 hours.

In other words, this is for babies who can be stabilized with bag-mask ventilation but who do not breathe adequately when you stop bagging. Always follow the basic steps of NRP and think about basic life support interventions (stimulation, bagging, etc) before even thinking about drug administration, even if you're sure that narcotics are the problem.

Like Elvish says, NRP cautions not to give naloxone to a baby born to a mom with suspected narcotic addiction. It can cause life-threatening withdrawal and status epilepticus in the baby.