Infant Identification Algorithm

* Mother attended her community drug and alcohol team (CDAT) were she was on a methadone programme. Referral was made by her key worker stated concerns that she may be pregnant and concealing it

The use of heroin, cocaine, and other illicit drugs has become a public health concern especially during pregnancy. Maternal substance abuse has become an issue during the crack epidemic in the 1980’s; however, there is an alarm rate of infants born addicted to heroin. More than 3.7% women have indicated the uses some form of illicit drugs during their pregnancy, as well as 1.9 % reports binge drinking (Bhuvaneswar el at., 2008; Grant el at., 2009). With this in mind, more than 375,000 infants are born to maternal substance abusers each year costing over $100,000 in medical expenses covered by the state (Reitman, 2002).

Prenatal exposure of a child to harm due to the mother’s use of an illegal drug or other substance.

Substance abuse during pregnancy can have a negative force on the health and wellness of not only the fetus, but that of the mother. The harmful effects of medications, alcohol and illegal drugs on an unborn child can be devastating and can have significant consequences to its use. Sometimes the effects can be faced and treated, and other times the outcome is a lifelong challenge. During the prenatal period, it is important that new mothers are informed of the different types of abuse, how they may affect the fetus, and the adverse conditions their child may be faced with before and after birth.

Many researches are educating pregnant women about the danger of cigarettes, alcohol and the potential negative effects of cigarettes, alcohol on fetus development. However, scarce research directly addresses specific effects of marijuana on pregnant women because women who use marijuana also tend to smoke cigarettes, drink alcohol and more likely to use other drugs such as cocaine and heroin. Thus, it is difficult to identify the precise effects of marijuana on pregnant women and on a fetus (Leemaqz, 2016.). Marijuana is the most commonly used illicit drug in the United State (Murray & McKinney, 2014). According to the American College of Obstetricians and Gynecologists, 40-60% of marijuana users continue to use during pregnancy. Studies have also shown that marijuana crosses the placenta negatively affecting brain development, and increasing the risk of pre-term birth. Proposition 64, the California Marijuana Legalization Initiative for adult use just passed after the election, California is added into the list of 26 states legalizing marijuana for medical or recreational purpose which could increase the number of women using marijuana during pregnancy. Due to above evidences, doctors warn pregnant women, women planning to pregnancy and breastfeeding women that they should discontinue their use of marijuana and should consider alternative therapy.

In 2014, after seeing a significant increase in babies born with neonatal abstinence syndrome (NAS), Tennessee began criminally charging pregnant women who use drugs (Sakuma, 2014). Supporters of the new legislation refer to it as a “velvet hammer” used to convince the pregnant drug users into going into treatment, or doing jail time. However, critics are concerned that this legislation will be just another barrier for a group of women who are already at risk, (Sakuma, 2014).

Through the years, substance misuse in the United States has turned into an industrious issue influencing numerous people. In 2008, it was assessed that 17.8 million Americans beyond 18 years old where substance subordinate. Women who use medications during pregnancy can have an enduring impact on fetal. Medications can have an impact of maternal and child wellbeing, yet there are a lot of different variables, which influence it, poor social environment, nourishment, cleanliness, and sexual abuse. Regenerative interruption connected with heroin utilization has been shown in both and women and even low dosages of opiates can impede ordinary ovarian capacity and ovulation. The harm that goes hand in hand with substance utilization comes either straightforwardly from the impact of the medication itself or from issues identified with development and/or unexpected labor. The entanglements of jumbling components clamorous way of life, poor nourishment, liquor utilization and cigarette smoking influence the appraisal of the impacts of cocaine in pregnancy. In obstetric practice, 100% of pregnant women utilizing cocaine or heroin are cigarette smokers. Cigarette smoking is presumably the most well known manifestation of substance utilizes and is noteworthy corresponding considering ladies who use unlawful medications. Babies whose moms smoked in pregnancy have a tendency to have lower conception weights and diminished length, cranial and thoracic

The use of controlled substances throughout pregnancy is a very prevalent issue among society today. Controlled substances have devastating effects on not only the mothers using the substances, but also infants while they are in utero and after they are born. Many infants born to mothers, who are abusing drugs, suffer from life threatening illnesses and are forever affected through adulthood. Specifically, heroin is a common drug form that is often used during pregnancy and results in the life threatening effects mentioned above.

The data showed that between 2009 and 2010, 16.2 percent of women between the ages of 15-17 years old, 7.4 percent of women between the ages of 18-25 years old, and 1.9 percent of women between the ages of 26-44 years old had used illicit drugs while pregnant. The data also showed substance abuse during pregnancy among different ethnic and racial groups. African Americans had the highest percentage in 2010 at 10.7 percent. The next highest was the White population at 9.1 percent. Hispanics or Latino’s percentage was 8.1 percent and the Asian population had the lowest percentage at 3.5 percent (“Results from”, 2011).

The use of illicit drugs and abuse of alcohol exact a steep price from our society. Substance abuse is a factor in many serious ills such as crime. More upsetting, however, is the affects that it has on children born affected from their dependent mothers. The National Institute on Drug Abuse estimates that 60 percent of women of childbearing age consume alcoholic beverages despite the fact that alcohol consumption during pregnancy is implicated in a wide range of birth defects and developmental disabilities, including mental retardation, physical abnormalities, and visual and auditory impairments. (Nevitt, 1996)

“Every 25 minutes, 1 baby is born suffering from opiate withdrawal. Newborns with neonatal abstinence syndrome (NAS) are more likely than other babies to also have low birth weight and respiratory complications” (Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome, 2015, Paragraph 2). To insure a better life for these babies, people are trying to create an Act called the Plan of Safe Care Improvement or otherwise known as the Infant Plan of Safe Care Improvement. This Act is meant to protect future babies from not only being born drug dependent because of their mothers, but also ensuring them a drug-free environment after birth. It will also “get help for the mothers and any other guardians involved in drug addiction”

According to Lowe (2017), “…across the United States, a woman presents every 3 minutes to an emergency department for opioid misuse or abuse” (p.657). With the significant increase in the misuse of opioids over the last thirty years in the US, it has become a serious public health concern. With the most dramatic rise in opioid use being of childbearing age women, it is a very important issue in maternal health care (Keough & Fantasia, 2017). It is imperative that nurses are informed and have efficient knowledge of the potential risks, effects, treatment, and prevention of opioid dependence during pregnancy.

After reading about various topics regarding drug addiction, it wasn’t easy to narrow down this topic. Drug addiction and pregnancy was the topic found to be most interesting. Estimates based on court documents, news accounts, and data collected by attorneys representing pregnant women indicate that at least 200 women in more than thirty states have been arrested and criminally charged for their alleged drug use or other actions during pregnancy (Moore, 2010). Should pregnant women struggling with drug addiction be criminally prosecuted? This is a

There have been significant changes in how society views and deals with prenatal drug usage. Roussell, Holmes, and Anderson-Sprecher (2009) states that according to lots of information collected concerning the usage of meth that prevention policies have been placed into effect to deal with the problem (p.1037). These policies affect us in various ways.

(n.d.) also conducted a study focused on infants that were exposed to buprenorphine or methadone while in utero. Unlike MacMullen et al. (2014) their focus was on predicting how the symptoms of NAS might manifest in the exposed newborns. Since the 1970s (MacMullen et al., 2014) methadone has been the treatment of choice for mothers with opioid dependence during pregnancy, the use of this drug allows for a decrease in withdrawal symptoms for the child after birth. The main categories of symptoms include central nervous system hyperirritability, gastrointestinal dysfunction, respiratory distress and vague autonomic symptoms (MacMullen et al., 2014). Although methadone has been being used for many years buprenorphine has only been used since 2002 in the United States (MacMullen et al., 2014). Their research was consistent with Kaltenbach et al. (n.d.) in that infants born to buprenorphine-exposed mothers had lower scores for NAS than those born to methadone-exposed mothers, but still had varying severities of symptoms and scores across all infants. For at least 10 days after birth, an expert scored the newborns on a modified Finnegan scale every 4 hours. The results showed that high birth weight was often a predictor for high NAS scores, along with lower NAS scores for infants delivered by cesarean section. MacMullen et al. (2014) were unable to find any connection between the use of methadone and buprenorphine to indicators of symptoms of NAS. The main