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Identifying and assessing the substance-exposed infant
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.
Insights
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.
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.
Abstract:
As the rate of opioid prescription grows, so does fetal exposure to opioids during pregnancy. With increasing fetal exposure to both prescription and nonprescription drugs, there has been a concurrent increase in identification of Neonatal Withdrawal Syndrome (NWS) and adaptation difficulties after birth. In addition, extended use of opioids, barbiturates, and benzodiazepines in neonatal intensive care has resulted in iatrogenic withdrawal syndromes. There is a lack of evidence to support the use of any one specific evaluation strategy to identify NWS. Clinicians caring for infants must use a multimethod approach to diagnosis, including interview and toxicology screening. Signs of NWS are widely variable, and reflect dysfunction in autonomic regulation, state control, and sensory and motor functioning. Several assessment tools have been developed for assessing severity of withdrawal in term neonates. These tools assist in determining need and duration of pharmacologic therapy and help in titration of these therapies. Considerable variability exists in the pharmacologic and nonpharmacologic approaches to affected babies across settings. An evidence-based protocol for identification, evaluation, and management of NWS should be in place in every nursery. This article provides an overview of identification and assessment considerations for providers who care for babies at risk for or who are experiencing alterations in state, behavior, and responses after prenatal or iatrogenic exposure to agents associated with the spectrum of withdrawal.
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