Use of Methadone for NAS Infants

RainDreamer, BSN, RN · Dec 4, 2006

We use oral methadone for NAS infants. We initiate the abstinence scoring right away and if they score high enough they get started on methadone. I actually just had a baby last night that was scoring rather high and he was started on methadone. His momma's drug of choice was cocaine, heroin, and who knows what else. Ah good times. Poor kid.

Zippedodah · Dec 4, 2006

We use methadone for most withdrawls. We don't send kids home of methadone...esp. if the parents are users.

TiffyRN, BSN, PhD · Dec 4, 2006

I've heard of other units using morphine or opium drops (paregoric?) but ours uses methadone. The last couple of kids I've seen the moms were on methadone programs anyway (though maybe supplementing their doses with heroin? who knows). They start them on doses of either 0.1mg to 0.2mg per kg per dose, dosed q6hrs, then stretched to q8hrs then q12, then once a day, then they will start cutting the dose down. Usually works well.

Our docs will NOT send kids home on methadone, they feel it's too high risk for the mom to take the meds. We did have to send one child home on phenobarb because he would just have seizures every time methadone was completely taken off, but did ok eventually on just phenobarb. He failed many attempts to wean off the phenobarb though. We all still think of him since he was with us so long (2months just for NAS, no other issues).

MegNeoNurse · Dec 5, 2006

We use methadone for most withdrawls. We don't send kids home of methadone...esp. if the parents are users.

You guys send kids home with parents who are admitted narcotics users which causes the kid to be on methadone? :no: Usually social work steps in and yadda yadda to prevent that from happening (parents like that having custody.)

dawngloves, BSN, RN · Dec 5, 2006

You guys send kids home with parents who are admitted narcotics users which causes the kid to be on methadone? Usually social work steps in and yadda yadda to prevent that from happening (parents like that having custody.)

Oh yeah! If the parent is in a program and has a clean house, they go home with them, no matter their drug of choice.

dawngloves, BSN, RN · Dec 5, 2006

Have those that have used MSo4 in the past seen a difference between it and methadone? We've alway been told that it causes seizures and that is why we use MSo4.

PremieOne · Dec 5, 2006

We are seeing major hypertension in the infants we have on Methadone. From what I am hearing from other NICUs it is taking a much longer time to wean these infants off Methadone. Our Neo Docs refuse to go back to Morphine solution because they need to give it q3-4h and with Methadone you only give it daily or BID.

Does anyone have a list of side affects for methadone use on withdrawing infants?

Zippedodah · Dec 5, 2006

Oh yeah, if the mom is on the program and there aren't any X's in her box, then Baby goes with Mommy. Or if there aren't any foster homes available in the county, then Baby goes with Mommy. I haven't really noticed any bad side effects, and the hypertension may be because they are so agitated. I don't know.

RainDreamer, BSN, RN · Dec 6, 2006

You guys send kids home with parents who are admitted narcotics users which causes the kid to be on methadone? Usually social work steps in and yadda yadda to prevent that from happening (parents like that having custody.)

You'd be amazed at what kind of "parents" we send some of these kids home with!! It's really scary .....

TiffyRN, BSN, PhD · Dec 6, 2006

Around here CPS has what they call a "safety plan". It means that the baby goes home with the mom but they have to have a responsible adult (usually grandma or husband/boyfriend) who promises to always supervise the mom and baby. Right!!! Such a complete joke!!!

But I digress; this isn't a thread about the silliness of CPS procedures and decisions.