Neonatal Abstinence Syndrome Research Paper

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).

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.

About half of the jail reported that pregnant women who were addicted to opioids went through withdrawal

When a woman uses heroin while pregnant, her baby is at risk for many challenging effects that will ultimately follow him or her as they grow into an adult. As heroin enters a mother’s system, the drug crosses into the child through the placenta (“Heroin Addiction”, n.d.). While a baby is in utero, a mother’s substance abuse can cause a fetus to grow at a slower rate, lead to the rupturing of the membranes surrounding the baby that results in premature labor, and cause a possible stillbirth, which means the fetus dies in the womb (“An Overview of Heroin”, n.d.). Substance abuse can also cause the placenta to separate from the uterine wall leading to dangerous heavy bleeding, which is a threat to both mother and child (“Heroin and Pregnancy,” 2015). Along with possible placenta abruption, the use of heroin can lead to the intrauterine passage of meconium (“Opioid Abuse,” 2012). After labor and delivery, the effects

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 National Health Institute (NIH) explains that addictive drugs such as amphetamines, cocaine, barbiturates, diazepam, and opiates consumed during pregnancy pass from mother to the fetus by crossing the placenta. This causes the baby to become addicted to these drugs along with the mother. Once born, the newborn no longer receives these drugs which then results in NAS (“Neonatal abstinence syndrome”, 2012a).

Risk Factors: addiction in mother, no prenatal care, no support system for mother, high stress levels in mother

Besides preventing withdrawal, methadone treats the mom’s opioid addiction. About 70% of pregnant opioid addicts will relapse back to illicit opioid use (heroin or pain pills not prescribed to them) if they are taken off methadone. We also know that women enrolled in a methadone treatment program are much more likely to get prenatal care, and babies born to moms on methadone have higher birth weights than mothers in active addiction. If the mother is dosed with methadone, the baby is much less likely to be exposed to infectious agents like HIV and hepatitis from shared needle use. The baby also won’t be exposed to adulterants that can cause fetal damage, if heroin is being used.

Problematic substance use in pregnancy is prevalent among the Canadian population. The statistics are well documented in the literature. According to a Health Quality Ontario report from 2012, about one in 100 pregnant women giving birth in Ontario hospitals shows substance use. The rate of substance abuse among pregnant women has increased since 2009 by about ten percent. Dow et al. (2012) identify that the management of substance use is particularly problematic in Northern Ontario. Many First Nations communities are in a state of emergency regarding abuse of prescription narcotics (Dow et al., 2012, p. 489).

Methadone is typically given to treat opioid dependence. This drug, which is a mu-opioid agonist, works by limiting withdrawal symptoms and the desire to use opiates. However, methadone has been shown to have a high incidence of causing neonatal abstinence syndrome (NAS) in the child. This leads severe problems in the infant such as, hyperirritability of the central nervous system, autonomic system malfunction, respiratory disorders, and others. NAS results in longer hospitalization and more

(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

Opioid addicted babies need treatment in the hospital setting to help them through the withdrawal process. Studies are showing what medications to use to help reduce the length of hospital stay. Today, many neonates stay in the hospital much longer than years past, this is generally due to being born addicted to opioids. The United States is suffering from an epidemic of opioid abuse. When a pregnant mother is addicted to opioids these drugs cross the placenta, causing the neonates to be born addicted. According to Hall et al. (2015), this epidemic can cause opioid misuse, overdose or even death. When looking at the United States from 2005-2011, “more than 14% of pregnant women were dispensed an opioid at some time in their pregnancy”, (Hall, 2015, pg.40). Depending on the length of medication used and timing during the pregnancy will determine how a neonate will withdraw after birth. This withdrawal is becoming a common practice and is known as Neonatal Abstinence Syndrome (NAS). By 2015, this syndrome would affect one neonate in 200 births. Improvements in medications and techniques help neonates get through withdrawal. I have created a PICO to help form this paper. This paper will compare the two medications; Morphine and Buprenorphine are most commonly used to help neonates withdrawing in the

NAS is caused from the use of illicit drugs or substances during a mother’s pregnancy. In a recent study done to show the actuality of women using illicit drugs it was discovered that 4.5% of women reported drug usage. These women ranged anywhere from 15 to 44 years old (11). When mothers use drugs they are often not thinking of the harmful effects it could have on their unborn child or are so addicted that they cannot physically stop abusing them themselves. In a recent study, it showed that 11 to 16% of all pregnant women were taking at least one illicit substance (6). This may not seem like a lot of people but it is a substantial amount of women when you are looking at only those that are pregnant. Also, the mothers who used drugs while they were impregnated were also more likely to use multiple substances (1). The substances used all have their own effects but some general side effects from most drugs on the fetus

Infants of regular heavy users usually have a low birth weight, because of intrauterine growth retardation and frequent premature births. (http://www.bookrags.com/research/addicted-babies-edaa-01/) Also if you are regularly abusing the drug, the infant may be born physically dependent on heroin. Children born to addicted mothers are at greater risks of SIDS (Sudden Infant Death Syndrome) as well. (http://www.uatests.com/drug-information/heroin.html) Tiffany looks over at Cassandra with tears running down her face and tells her, “I don’t know what to do? I want to stop but I can’t! I need to use heroin, I can’t go a few hours without it.” Cassandra hugs her and tells Tiffany, “Yes you can stop! You just need a little help and support, but you also have to know the risks you pose to yourself.”

stop taking a narcotic. Symptoms include strong desire for the medicine (craving), yawning, insomnia, restlessness, mood swings, or diarrhea. To prevent withdrawal symptoms, your doctor may recommend you gradually lower the dosage over time.