With the rise of opiate drug use and overdose nationwide, nurses are observing an increase in maternal drug use during pregnancy. Between the years 2000 and 2009, the prevalence of infants diagnosed with drug withdrawal (or neonatal abstinence syndrome [NAS]) increased nearly three times and maternal opiate use increased about five times. Substance use during pregnancy is associated with birth defects, low birth weight, premature birth, seizures and neurobehavioral or cognitive defects.
In “Management of Neonatal Abstinence Syndrome in the Newborn Nursery,” Valarie Artigas, MSN, NNP-BC, wrote about managing neonatal withdrawal symptoms from maternal drug use during pregnancy. This article appears in the December 2014/January 2015 issue of Nursing for Women’s Health, the clinical practice journal of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN).
Newborns experience NAS as a result of their no longer being exposed to the addictive substance(s) they were exposed to in the womb. Essentially, infants are experiencing withdrawal symptoms and may need medical intervention. Clinical presentation for NAS is influenced by many factors, including the types of drugs used, the timing and amount of last drug use, and the metabolism of the drugs by newborns. Some infants may show withdrawal symptoms immediately after birth or others up to four days later.
Drug-exposed newborns begin a withdrawal process following birth, causing neurologic, gastrointestinal and autonomic nervous system symptoms. Generally, infants exposed to nicotine, alcohol or marijuana do not show withdrawal symptoms, but they may experience abnormal behaviors that normalize over time. Infants with NAS experience hyperirritability that can be exacerbated by overstimulation in their environment.
With maternal history playing a strong role in diagnosing and managing NAS, it’s important for nurses to review the maternal health record when a newborn shows withdrawal symptoms. Newborns’ behaviors and responses to interactions and their environment should also be assessed to determine the need for specific soothing techniques, such as a quiet environment with low lighting and soft voices. The newborn may also need clustering care and swaddling, pacifiers to promote self-soothing, frequent, smaller feedings, and vertical rocking to decrease hyperactivity. Clinical scoring tools can be used to measure the severity of withdrawal symptoms in infants to aid in deciding if medication is needed, such as oral morphine and methadone.
While there is ongoing debate, research has found shorter hospital stays and decreased need for medications when newborns and mothers are not separated. Family-centered care also promotes attachment between mothers and infants. However, infants needing medication are traditionally cared for in a hospital setting (and not at home) so that they can be monitored.
“Nurses serve a vital role in caring for infants who were exposed to drugs in utero,” said AWHONN’s CEO, Lynn Erdman, MN, RN, FAAN. “Nurses can help by working to develop a screening process and treatment guidelines to effectively identify and support these vulnerable mothers and infants.”
To support the ongoing clinical practice of nurses, AWHONN recently issued a new position statement entitled, “Criminalization of Pregnant Women with Substance Use Disorders.”The statement outlines AWHONN’s opposition to laws and other reporting requirements that result in incarceration or other punitive legal actions against women because of a substance abuse disorder in pregnancy. Further, the statement underscores the importance of universal screening and early identification of pregnant women with substance use disorders for the purpose of initiating referral for treatment and specialized prenatal care.
About Nursing for Women's Health
Nursing for Women's Health is a bimonthly refereed clinical practice journal of the Association of Women's Health, Obstetric and Neonatal Nurses. The journal circulates to more than 25,000 nurses who care for women and newborns and is available online at http://nwh.awhonn.org.
DOI: 10.1111/1751-486X.12163
About AWHONN
Since 1969, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) has been the foremost authority promoting the health of women and newborns and strengthening the nursing profession through the delivery of superior advocacy, research, education and other professional and clinical resources. AWHONN represents the interests of 350,000 registered nurses working in women's health, obstetric, and neonatal nursing across the United States. Learn more about AWHONN at www.awhonn.org.
