MCOSA, MPN, MISD, MCTFT, and CADCA
sponsored
DRUG DEPENDENT NEWBORNS
July 20, 2012
Key Concepts:
 Understand the scope of the problem
 Learn how prescription-dependent babies are treated
 Understand why some pregnant women do not seek help
 Law enforcement and emergency responders play a role in protecting these
babies
What is Neonatal Abstinence Syndrome (NAS)?
 Signs and symptoms of newborn babies whose mothers have used drugs during
pregnancy. Symptoms are typically called withdrawal symptoms, because baby
has been separated from the mother and the infant has lost the supply of drugs
after he/she is born.
 Withdrawal from the drug happens within seconds of the baby being born.
However, onset is typically around 72 hours.
 One problem is that if a mother has a normal delivery, she is usually released
from the hospital on the second day, and the baby’s withdrawal may not have
begun. When withdrawal begins (after baby is home), the mom may or may not
bring the baby back to the hospital.
 Can mimic other conditions
 Severity is not an indicator of maternal treatment compliance
Symptoms
 High pitched cry
 Fever
 Abnormal muscle tone
 Poor feeding
 Tremors
 Vomiting, diarrhea
 Excessive sucking
During pregnancy the drugs pass from the placenta to the baby. After birth, baby suffers
from withdrawal.
East Tennessee Children’s Hospital NICU unit
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There are 152 beds in the NICU unit and 60 beds in Level III NICU
About 20% of NICU admissions are primarily for Neonatal Abstinence
Syndrome (NAS)
In 2011, there were 135 admissions
Between July to December 2011, the average number of babies in NICU for
NAS was 19 - or 40% of the NICU population
The highest daily census was 27
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Approximately 70% of the Neonatal Abstinence Syndrome babies:
Were weaned from opioid in about 20 days
Do not require adjunctive treatment
Stay in the NICU for about 24 days
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Approximately 20% of the Neonatal Abstinence Syndrome babies:
Require weaning time of 60 days (with a range up to 120+ days)
Require adjunctive treatment with one or two additional medications
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How is Neonatal Abstinence Syndrome diagnosed?
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Prenatal Care
History of siblings
History of ER visits
What are the ways to test babies for Neonatal Abstinence Syndrome?
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First urine will detect very recent substance use
First meconium will detect substance use after 20 weeks gestation
Finnegan scores
Very little is known about long-term effects on babies that are exposed to
heroin/methadone, although they may experience behavioral problems.
Barriers to treatment include:
 Fear, shame and guilt about use
 Lack of services for problems of pregnancy and addiction
 Co-morbid diagnosis impacts ability to access services
What one state is doing to decrease Neonatal Abstinence Syndrome
Tennessee Initiative for Perinatal Quality Care
Goals of the Initiative are:
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Toolkit: Optimizing Neonatal Abstinence Syndrome Management
Identify NAS prevalence in Tennessee
Engage OB/GYN and Labor/Delivery to initiate early treatment plan
Identify strategy for breast milk use for NAS infants
Broadcast Content Providers:
Dr. Henrietta Bada-Ellzey, Neonatologist, Professor of Pediatrics, College of Medicine, University of Kentucky, Lexington, KY.
Dr. Henrietta Bada-Ellzey is a Professor of Pediatrics at the University of Kentucky College of Medicine and a Professor at the
College of Public Health. She also serves as Vice-Chair for Academic affairs and Research in the Department of Pediatrics. Her
subspecialty is neonatology, dealing with the intensive care of the premature and high-risk infants
Kay M. Doughty, Vice President of Family and Community Services, Operation PAR, Inc., Pinellas County, FL.
Kay Doughty has spent 25 years working in the field of Substance Abuse as a supervisor of prevention, intervention and
treatment programs, including methadone maintenance.
Sheri Smith, Director of Critical Services, East Tennessee Children's Hospital, Knoxville, TN.
Sheri Smith has been practicing the art of nursing for the past 27 years, all of them in the neonatal and pediatric setting.
Links from Drugged Dependent Newborns:
Pediatric Interim Care Center, The Newborn Nursery, (PICC) - http://picc.net/
Live Smart, Live Free! Coalition - http://www.pinellascoalition.com/
SAMHSA Substance Abuse Treatment Facility Locator - http://findtreatment.samhsa.gov/
Operation PAR- http://www.operationpar.org/
March of Dimes - http://www.marchofdimes.com/
All Children's Hospital - http://www.allkids.org/index.html
Florida Office of the Attorney General - http://myfloridalegal.com/
East Tennessee Children's Hospital - http://www.etch.com/
Drug Use During Pregnancy Brochure from East Tennessee Children's Hospital - http://www.etch.com/
View this broadcast at: http://www.mctft.com, click on “Broadcasts/Videos”,
then click on “Past Broadcasts”.
For more information on upcoming webinars, visit MCOSA’s website at:
www.mcosa.net, click on Prevention, then click on Macomb Prevention Network