Case Scenario as an FNP Peer Response Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:
Do you agree with your peers’ assessment?
Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
Share your thoughts on how you support their opinion and explain why.
Present new references that support your opinions.
Please be sure to validate your opinions and ideas with in text-citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. Be respectful and thoughtful.This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Minimum of 100 words.
Neonatal Abstinence Syndrome
A infant that is born with a mother that has been using opioids during pregnancy is known as neonatal abstinence syndrome (NAS). It can also occur with the use of nicotine, benzodiazepines, and SSRIs that are taken during pregnancy (Jansson, 2019). Another term used for opioid withdrawal in infants is neonatal opioid withdrawal syndrome (NOWS). It is diagnosed with a history of maternal opioid use, positive paternal or infant urine toxicology screening, and neonatal findings that are consistent with NAS (Jansson, 2019).
Peri-natal Risks to Infant
The infant during the peri-natal phase is at risk for many of things. There is a risk of placental abruption, placental insufficiency, preterm rupture of membranes, premature labor and birth, fetal grown restriction, preeclampsia, miscarriage, fetal death, inflammation of fetal membranes leading to an infection (Mayo Clinic, 2017). Women with an opioid addiction are less likely to have prenatal care which can lead to other complications that are not even associated with the opioid use. The infant will not be getting the proper nutrition it needs to grow and might have other deficits as a result such as a neural tube defects from not taking folic acid supplements.
Post-natal Risks to Infant
If the infant makes it to delivery, there are many complications that the infant is going to begin to experience as their opioid supply is abruptly cut off. The infant will show signs of NAS as they will have a high-pitched cry and irritability, sleep and wake disturbances, hyperactive primitive reflexes, hypertonicity, tremors, difficulty with feeding, gassiness, vomiting, diarrhea, diaphoretic, sneezing, mottling, fever, nasal stuffiness, yawning, failure to thrive, seizure activity, small gestational age, respiratory distress, and possible cardiac birth defects (Jansson, 2019). The symptoms that the child will experience are horrible and lead to death in the infant if not managed properly.
Post-natal Risks to Mother
The mother is also at risk if she delivers in result of placental abruption or preterm labor. The mother is at risk for hemorrhage and infection if there is a premature rupture of membranes and the mother does not seek the proper medical care (Jansson, 2019). The mother may also experience opioid withdrawals during the postpartum phase after delivery if she is trying to stop using. Another risk for the mother is losing custody of the baby. If the baby is born with NAS, social work will get involved and investigate the situation and living conditions of the home, etc. Many women with opioid addiction might also experience depression, anxiety, PTSD, bipolar disorders, HIV, sexual violence, and hepatitis C (Krans, Cochran, & Bogen, 2015).
Long-term Affects on Infant
Long term effects on the infant may include HIV, hepatitis C, or other STDs that were transmitted to the baby during delivery (Jansson, 2019). If the child was born with low birth weight, premature, or insufficient nutrients or oxygen supply during pregnancy, the child may experience other long-term effects. The child may be developmentally delayed, failure to thrive, and possible cardiac complications (Jansson, 2019). Medication can be used to manage the infant and their symptoms to hopefully get the infant to go through a safe withdrawal.
Jansson, L. (2019). Neonatal abstinence syndrome. UpToDate. Retrieved from https://www.uptodate.com/contents/neonatal-abstinence-syndrome?search=neonatal%20abstinence%20syndrome&source=search_result&selectedTitle=1~100&usage_type=default&display_rank=1#H16 (Links to an external site.)Links to an external site.
Krans, E., Cochran, G., & Bogen, D. (2016). Caring for opioid dependent pregnant women: prenatal and postpartum care considerations. National Institute of Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC46070…
Opioid use during pregnancy. (2015). MayoClinic. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/pregn…
Neonatal Abstinence Syndrome
Neonatal Abstinence Syndrome (NAS) is a name given to a group of problems that occur in a newborn who has been exposed to addictive opiate drugs in the mother’s womb. These drugs include heroin, codeine, oxycodone, methadone or buprenorphine. When the mother uses these drugs, they pass through the placenta and the fetus along with the mother becomes dependent on the drug. If the drugs are used within a week of the delivery the baby will be born dependent on the drug at birth. When the infant is born it may experience withdrawal symptoms as the drugs are cleared from the baby’s system. When the mother uses amphetamines, cocaine, and marijuana the child might have long term effects (U.S. National Library of Medicine, 2018).
The impact to the infant depends on the type of drug used, how much of the drug was being used, how long she was using, and if the baby was born full-term or premature. Symptoms typically begin 1 to 3 days after birth but can take up to one week (U.S. National Library of Medicine, 2018) . Symptoms are often manifested by central nervous system irritability (e.g., tremors, increased muscle tone, high-pitched crying, and seizures), gastrointestinal dysfunction (e.g., feeding difficulties), and temperature instability (Ko, et al., 2016). Other symptoms can include:
Blotchy skin coloring (mottling)
Excessive crying or high-pitched crying
Increased muscle tone
Slow weight gain
Stuffy nose, sneezing
Vomiting ( (U.S. National Library of Medicine, 2018).
The child born with NAS often require extra TLC for weeks to months. Some babies with severe symptoms need medicines such as methadone or morphine to treat withdrawal symptoms. These babies may need to stay in the hospital for weeks or months after birth. The goal of treatment is to prescribe the infant a drug similar to the one the mother used during pregnancy and slowly decrease the dose over time. This helps wean the baby off the drug and relieves some withdrawal symptoms (U.S. National Library of Medicine, 2018). There is limited knowledge available about the long-term effect of infants born on drugs.
This is a topic that hits close to home and has personally impacted my life. Six months ago, I received a call asking if I would take in two children who once belonged to a friend of mine of 20 years otherwise they would be going into a random foster home. A 4-year-old girl and her 8-month-old brother. I had been watching the children as much as I could prior because I knew things were not good at home but I had become distant from the mother and was not aware to the extent of the situation. Upon getting the children I was made aware of the situation and found out that the mother overdosed twice during her pregnancy with the little boy, and he was born positive to a few different drugs. We have worked with Birth to Three and with his pediatrician for evaluation and development. I am happy to report that he is absolutely perfect and developing well. We worry about what the future will hold for him but continue to provide him with all that we can to promote and healthy growth and development.
Ko, J. Y., Patrick, S. W., Tong, V. T., Patel, R., Lind, J. N., & Barfield, W. D. (2016, August 12). Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/65/wr/mm6531a2.ht…
U.S. National Library of Medicine. (2018). Neonatal abstinence syndrome. Retrieved from Medline Plus: https://medlineplus.gov/ency/article/007313.htm