Neonatal Methadone withdrawal

[htrn]

Looking to the smartest nurses I know for some help here.

We just had a baby the other day, mom on 30mg methadone daily during pregnancy due to a pain killer addiction after a back injury. She made it abundently clear to her 'addiction specialist' that she wanted to breast feed, but has since been told that she can't nurse until she gets her methadone level to 20mg/day or lower. So we cut her to 20mg/day, but she is also getting percocet for post C-section pain.

This is such a complicated situation as this is the first baby we have ever dealth with like this - turns out most other moms are referred to a tertiary care center for delivery. I wish I knew why she wasn't.

Anyway, now doing the neonatal abstinence score on him, but have heard that there is also an alogorhythm for when to administer morphine if kids scores over 8 and then he is supposed to stay on scheduled morphine for atleast 24 hours. I can't find anything on this alogorhythm. He has only scored over 8 twice and did get two doses of morphine for that, but that is it.

Please help. I feel terrible for this family as they are really trying to do what is best for her and the baby. This poor mom begged me to tell the other nurses and doctors that she wasn't an awful person and she was doing what her doctors told her to do - and now it turns out it was wrong.

Thanks again for any advice, references, help, etc...

[dawngloves, BSN, RN]

She must have had a serious narcotic addiction to be on methadone. The best treatment for a pregnant woman is methadone, less side affects on the fetus.Did her doctor tell her she can breast feed on it? If so, they are seriously misinformed.

I'm sure no one is judging her and by getting treatment she obviously cares. So she must realize that now isn't the best time to breast feed. There are times that that is acceptable.

Is this baby on schedualed MSo4? We will start a methadone baby on MSo4 and wean based on the NAS, not administer.Only a rescue dose will be administered based on NAS, greater than 12 and such.

Perhapes your physicians should call over at the tertiary facility and ask them how they wean their pts. If this baby is only a couple of days old, you really havent' seen the full withdraw yet. Good luck!

[BittyBabyGrower, MSN, RN]

Dawn is right. Moms that are on methadone aren't supposed to BF....esp if they are on high levels. We start them on morphine and wean according to scores, you can't just give it randomly. In a few days that baby is going to be one miserable tyke with lots of withdrawl symptoms as mom is on a big dose of Methadone. If your hospital isn't comfortable with this, then maybe they should ship the baby to level 3 so that they can wean the baby.

[htrn]

Thanks for the words of wisdom. I feel like a fish out of water with this and so do most of my colleagues. We, the nurses, found out about her coming in less than two days before her scheduled induction and the docs feelt like it was OK to have him in our hospital. Not a popular opinion with some nurses, and now the little guy, and her parents, I hate to say, may not get exactly the best they all deserve.

I would love to have him shipped, but I don't know if that will happen. Our tertiary care centers are many miles away (75-100).

I am sick of making excuses to this family and for our docs, this kid never should have been born with us, I'm not sure the mom got the best advise from her 'addictions specialist', and I am dying to just tell them to get that kid to the tertiary care center themselves. But I will continue to try to be as tactful as I can and fight behind the scenes to get him what he deserves.

This sucks!!