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Identifying and assessing the substance-exposed infant.

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  • 1Lisa Clark is a Nurse Practitioner, Newborn Nursery, Stony Brook University Hospital, and Adjunct Clinical Assistant Professor, Stony Brook University, School of Nursing, Stony Brook, NY. Annie Rohan is Director of Pediatric Research, Stony Brook University, School of Nursing, Stony Brook, NY, and a Nurse Practitioner, Neonatal Intensive Care Unit, Cohen Children's Medical Center of the North Shore-LIJ Health System, New Hyde Park, NY. She can be reached via e-mail at annie.rohan@stonybrook.edu.

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Summary

Neonatal Withdrawal Syndrome (NWS) is increasing due to prenatal opioid exposure. A multimethod approach including interviews and toxicology screening is crucial for diagnosis and management of NWS in newborns.

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Area of Science:

  • Neonatalogy
  • Pharmacology
  • Public Health

Background:

  • Increasing opioid prescriptions lead to greater fetal exposure and a rise in Neonatal Withdrawal Syndrome (NWS).
  • Iatrogenic withdrawal syndromes can occur from medications used in neonatal intensive care, such as opioids, barbiturates, and benzodiazepines.
  • There is a lack of standardized evaluation strategies for identifying NWS.

Purpose of the Study:

  • To provide an overview of identification and assessment considerations for Neonatal Withdrawal Syndrome (NWS).
  • To guide healthcare providers in managing infants at risk for or experiencing withdrawal symptoms.
  • To highlight the need for evidence-based protocols in neonatal care.

Main Methods:

  • Review of current literature on NWS identification and assessment.
  • Discussion of multimethod diagnostic approaches, including clinical assessment and toxicology screening.
  • Examination of various assessment tools for quantifying withdrawal severity in neonates.

Main Results:

  • Signs of NWS are diverse, affecting autonomic regulation, state control, and sensory-motor functions.
  • Assessment tools aid in determining the need, duration, and titration of pharmacologic therapies.
  • Significant variability exists in current pharmacologic and nonpharmacologic management strategies across different clinical settings.

Conclusions:

  • A comprehensive, multimethod approach is essential for accurate NWS diagnosis.
  • Standardized, evidence-based protocols for NWS identification, evaluation, and management are needed in all nurseries.
  • Effective management requires addressing the wide spectrum of withdrawal symptoms and contributing factors.