Running head: NEONATAL ABSTINENCE SYNDROME
Neonatal Abstinence Syndrome Nursing Interventions
Danielle Marie Ciambor
Lawrence Memorial/ Regis College School of Nursing
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NEONATAL ABSTINENCE SYNDROME
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Neonatal Abstinence Syndrome Nursing Interventions
Neonatal abstinence syndrome is a newborn narcotic withdrawal disorder and can occur
when a woman takes narcotics such as methadone, buprenorphine, codeine, oxycodone or heroin
during pregnancy. This disorder can affect the newborn’s breathing, nervous, and digestive
systems. The symptoms are inconsistent and may include breathing problems, seizures, poor
feeding, tremors, irritability, excessive crying, fever, diarrhea and vomiting (National Institutes
of Health [NIH], (2014).
In the United States, neonatal abstinence syndrome is an epidemic of growing proportion.
This has brought upon a major challenge for prenatal nurses on how to clinically manage the
symptoms of the ever growing population of newborns affected with neonatal abstinence
syndrome (Saunders et al., 2014). In response to the epidemic, standardized nursing
interventions need to be implemented to provide more effective care. The following discussion
will include an annotated bibliography on neonatal abstinence syndrome nursing interventions.
Annotated Bibliography
McQueen, K.A., Murphy-Oikonen, J., Gerlach, K., & Montelpare, W. (2011). The impact of
infant feeding method on neonatal abstinence scores of methadone-exposed infants.
Advances in Neonatal Care, 11(4), 282-290. doi: 10.1097/ANC.0b013e318225a30c
The authors investigated if the feeding method could make a difference on the neonatal
abstinence syndrome scores of newborns exposed to methadone in utero. The study
compared newborns who were solely bottle fed, combination fed (formula and breast
milk), or exclusively breast fed by analyzing if newborns experienced reduced symptoms
of neonatal abstinence syndrome when methadone was provided through breast milk.
The purpose of the research was to verify if feeding methods altered neonatal abstinence
syndrome scores of newborns subjected to methadone in utero. There were several
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limitations of the research; however, the most detrimental was the small group size of 28
newborns. Further research that could be done to expand knowledge in this area is to
discover if there are any valuable interventions to initiate and sustain breastfeeding in
methadone-maintained mothers.
The conclusion of the study was methadone-maintained mothers who breast feed their
newborns, along with other benefits, may reduce severity and duration of neonatal
abstinence syndrome. The main practice implication that relates to this study is teaching
in the prenatal period for methadone dependent mothers regarding the benefits of
breastfeeding for both mother and infant. Comparing this article with the other sources
referenced, a difference is this source specifically targeted methadone exposed newborns.
This is a useful source for specifying what feeding method should be recommended to
new mothers who are maintained on methadone.
Pritham, U.A., Paul, J.A., & Hayes, M.J. (2012). Opioid dependency in pregnancy and length of
stay for neonatal abstinence syndrome. Journal of Obstetric, Gynecologic & Neonatal
Nursing, 41(2), 180-190. doi: 10.1111/j.1552-6909.2011.01330.x
This article explores what factors affect the length of stay for newborns who are exposed
to opioid replacement therapy and other concurrent prenatal exposures. The study was
about determining the length of stay for newborns with neonatal abstinence syndrome
due to mother’s methadone or buprenorphine maintenance therapy and other factors such
as use of tobacco, alcohol, SSRIs, benzodiazepines, marijuana, other opioids and feeding
method. The objective of this research was to examine opioid replacement therapy and
other variables in pregnancy. The research also observed outcomes of infants with
neonatal abstinence syndrome, including length of stay. There were several limitations of
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the research; however, the most unfavorable was the unequal size of the buprenorphine
and methadone groups. Further research that could be done to expand knowledge in this
area is to determine the differences in neonatal abstinence syndrome in relation to initial
exposure and gestational age, along with the duration of exposure to opioid replacement
therapy.
The conclusion of this study is the concurrent use of tobacco, alcohol, SSRIs,
benzodiazepines, marijuana, and other opioids with opioid replacement therapy, during
pregnancy may impact the expression of neonatal abstinence syndrome and even
exacerbate the withdrawal symptoms. A major implication for practice is collaboration
between prenatal care providers, psychiatrists and addiction treatment specialists to
collectively emphasize alternatives that are non-pharmacologic to decrease any
unwarranted fetal exposure. In comparison to the other sources referenced, this study
broadened their scope of research to include other factors that would perpetuate neonatal
abstinence syndrome. This is a helpful source in identifying key factors, beside opioid
replacement therapy, that increase the length of stay for neonatal abstinence syndrome
infants.
Saunders, C., King, T., Smith, S., Buchheit, J., Cook, K., Edds, J., & Mefford, L. (2014).
Neonatal abstinence syndrome: Evaluating the effectiveness of an evidence-based
multidisciplinary care approach. Journal of Perinatal & Neonatal Nursing, 28(3), 232240. doi: 10.1097/JPN.0000000000000049
The authors evaluated if the evidence based multidisciplinary neonatal abstinence
syndrome protocol reduced the length of stay, weaning time from opioids and the use of
supplemental pharmacotherapy in newborns diagnosed with neonatal abstinence
syndrome. The study was about the development of the evidence-based multidisciplinary
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protocol and also to assess the effectiveness. The objective of the research was to evolve
a neonatal abstinence syndrome protocol using a stepwise continuous quality
improvement technique with the ultimate goal of standardizing care procedures for
neonatal abstinence syndrome newborns. A major limitation of the study was strict
control of confounding variables were unattainable due to rapid cycles of change.
Further research that could be done is to examine long term developmental and
behavioral outcomes of the children and family treated with the neonatal abstinence
syndrome protocol.
The conclusion of the study was to use a multidisciplinary approach when caring for
families with a neonatal abstinence syndrome diagnosed newborn, this addressed the
complex and dynamic care needs of both the family and the patient. A major implication
for practice is the research provided a protocol to follow for a newborn diagnosed with
neonatal abstinence syndrome that also included the family. Compared to the other
sources referenced, one of the major differences was the authors developed a neonatal
protocol, also the number of participates was much higher than those without an
established protocol. This research was useful in identifying specific evidence-based
nursing interventions.
Conclusion
The referenced sources aided in understanding the topic of nursing interventions for
neonatal abstinence syndrome, by providing evidence-based research. The studies found
compelling evidence to assist opioid-dependent mothers during prenatal care and also the
antepartal period to reduce the outcomes of neonatal abstinence syndrome. The findings enable
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nurses to narrow down tasks that they can perform to decrease the symptoms of neonatal
abstinence syndrome, which then decrease the length of stay for the infant.
Due to the ever growing population of infants born with neonatal abstinence syndrome,
evidence-based standardized nursing interventions need to be put into place to help decrease the
symptoms of neonatal abstinence syndrome. This would decrease the length of stay in the
hospital, which would hopefully, not put as much of a burden on the United States health care
system as it does today. Also, if there were standardized nursing interventions to follow, nurses
may feel a decreased burden when caring for an infant with neonatal abstinence syndrome.
The new knowledge acquired from these studies help future nursing practice by pointing
out steps of care to follow when treating an infant for neonatal abstinence syndrome. The studies
also highlight a missed opportunity to decrease the number or severity of infants born with
neonatal abstinence syndrome. Nurses could be available, at opioid replacement maintenance
programs, to offer education to pregnant women who are enrolled in the program. The nurse
could also share community resources to newly pregnant women, in hopes that they would
receive proper prenatal care. Education is an important aspect of this complex syndrome and is
imperative throughout the course of pregnancy and if possible, even before conception.
NEONATAL ABSTINENCE SYNDROME
References
McQueen, K.A., Murphy-Oikonen, J., Gerlach, K., & Montelpare, W. (2011). The impact of
infant feeding method on neonatal abstinence scores of methadone-exposed infants.
Advances in Neonatal Care, 11(4), 282-290. doi: 10.1097/ANC.0b013e318225a30c
National Institutes of Health. (2014). Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/007313.htm
Pritham, U.A., Paul, J.A., & Hayes, M.J. (2012). Opioid dependency in pregnancy and length of
stay for neonatal abstinence syndrome. Journal of Obstetric, Gynecologic & Neonatal
Nursing, 41(2), 180-190. doi: 10.1111/j.1552-6909.2011.01330.x
Saunders, C., King, T., Smith, S., Buchheit, J., Cook, K., Edds, J., & Mefford, L. (2014).
Neonatal abstinence syndrome: Evaluating the effectiveness of an evidence-based
multidisciplinary care approach. Journal of Perinatal & Neonatal Nursing, 28(3), 232240. doi: 10.1097/JPN.0000000000000049
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