Robin has a PhD in health psychology. She has taught undergraduate and graduate psychology, health science, and health education.
Defining Neonatal Abstinence Syndrome
You've no doubt seen words like these on every bottle of medication you've encountered, from over-the-counter pain relievers to antidepressants: 'If you are pregnant, ask your doctor before use.' It's well known that a developing fetus lives in a delicate ecosystem. In order to illustrate this, it is helpful to understand the anatomy of the womb and its connection to the fetus.
The fetus shares a connection with its mother through the umbilical cord. This is a tube-like structure that carries oxygenated blood and nutrients from the placenta to the fetus, and waste products away from the fetus. The placenta is an organ attached to the uterine wall that connects to the mother's blood supply, and nutrients, gases, medications, and other substances will pass through it and into the umbilical cord.
Because mother and fetus are inextricably connected during this time of development, the fetus is highly dependent on the mother for proper nutrition. In addition, it is highly vulnerable to any harmful substances the mother might ingest. Therefore, it is important for an expecting mother to avoid harmful substances. There is a wide range of medications and recreational drugs that can interfere with the proper development of a fetus and lead to short- or long-term problems after birth.
For this lesson, we will focus on opioids, opiates, and narcotics, which can lead to neonatal abstinence syndrome in the fetus. This syndrome, which is essentially withdrawal, can manifest in a variety of respiratory, gastrointestinal, behavioral, and nervous system-related problems. It is becoming more common; between 2000 and 2009, the incidence of this syndrome increased from 1.20 to 3.39 for every 1000 births. Before we delve further into the syndrome's symptoms and their treatment, it would be helpful to discuss the drugs themselves and how they work on the body.
Understanding Opioids, Opiates, and Narcotics
Opioids are a class of drugs that bind to opioid receptors in the body, and they are known to reduce pain, cause sedation, and produce feelings of euphoria. They can be used clinically in a hospital setting (e.g., after surgery) or prescribed to patients to manage pain over a longer period of time. They can also be used illegally as recreational drugs. Opioids include morphine, heroin, oxycodone, Percocet, codeine, and many others. People often use the term opioids interchangeably with opiates, but this is incorrect. The term opioids is a broader term that includes opiates.
The difference is that opiates are limited to the naturally occurring substance, called opium, that is found in the seed pod of a poppy plant. Whereas opioids can include completely or partially synthesized chemicals, opiates are not synthesized. For example, morphine and codeine are derived from naturally occurring opium and are referred to as opiates. Because heroin and oxycodone are derived from morphine, you might think of them as opiates. However, they also contain artificially synthesized chemicals. Therefore, they are referred to as opioids.
The definition of the term narcotics is more of a gray area and has changed over time in terms of what it includes. In the past, it was defined as any type of drug that can have analgesic, sedative, euphoric, and addictive effects. This used to include benzodiazepines, like Xanax, barbiturates, and even cocaine. Today, the term mainly refers to opioids and opiates. In legal terms, it is used to describe any drug that is completely prohibited or used in a way that violates its regulation. Regardless of the terminology, how they are derived, and how they are acquired, these drugs all have the potential for abuse and addiction.
Symptoms of Neonatal Abstinence Syndrome
Neonatal abstinence syndrome is essentially the fetus withdrawing from addictive opioids that passed through the placenta and umbilical cord from the mother. Although this lesson is focusing on drug use in the mother, the syndrome can also occur if the newborn withdraws from pain medication that was administered after birth for pain management. The symptoms vary based on the amount and type of drug used, how long it was used, and whether the baby was carried to full term or born premature. Signs and symptoms can appear a few days after birth and include:
- Excessive crying or screaming
- Slow growth and weight gain
- Mottled skin
- Trembling and/or seizures
Diagnosis involves asking the mother about her drug use during pregnancy, toxicology screening of the baby's urine and feces, and a scoring system based on the severity of each symptom. Luckily, there are ways to treat this syndrome, and the baby can have a positive prognosis. If alcohol was also ingested, however, this can further complicate things and lead to permanent damage. Otherwise, neonatal abstinence syndrome alone can typically be resolved between a week and six months with proper treatment.
Treatment of Neonatal Abstinence Syndrome
When the newborn shows signs of this syndrome or if there is suspected drug use in the mother, the baby will be monitored carefully for withdrawal, weight gain and feeding problems, and dehydration caused by vomiting. Intravenous feeding may be necessary to treat the dehydration, and higher-calorie formula can help induce weight gain. These infants tend to be difficult to keep calm, but swaddling and gentle rocking has been known to help. In severe cases, medications, such as methadone or morphine, may be administered to gradually ease the baby out of withdrawal. The barbiturate phenobarbital has also shown promise, particularly in reducing seizures.
Neonatal abstinence syndrome is a group of respiratory, gastrointestinal, and nervous system problems that can manifest in a newborn if his or her mother used opioids or opiates during pregnancy. Symptoms include feeding problems, vomiting, seizures, and excessive crying, and these can last up to six months. Treatment involves monitoring, high-calorie formula, IV fluids, swaddling, and medication in severe cases.
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