What Is The Understanding Of Brain Development In The PDA Gestation?

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).

Last year there were over 64,000 reported opioid-related deaths in the United States – making it the leading cause of accidental death in people under the age of 50 in this country (Katz). Opioids, also referred to as painkillers, have become a growing problem over the past two decades particularly in rural communities all across the country where the death rates are higher per capita compared to the death rate in cities (“America’s Opioid Epidemic is Worsening”). These narcotics, such as codeine, fentanyl, hydrocodone, morphine and oxycodone are extremely addictive and, as a result, this silent killer has quadrupled the overdose death toll since 1999

Opioid drugs are some of the most widespread pain medications that we have in this country; indeed, the fact is that opioid analgesic prescriptions have increased by over 300% from 1999 to 2010 (Mitch 989). Consequently, the number of deaths from overdose increased from 4000 to 16,600 a year in the same time frame (Mitch 989). This fact becomes even more frightening when you think about today; the annual number of fatal drug overdoses in the Unites States now surpasses that of motor vehicle deaths (Alexander 1865). Even worse, overdose deaths caused by opioids specifically exceed those attributed to both cocaine and heroin combined (Alexander 1865).

Infants born very preterm are exposed to considerable procedural pain-related stress during weeks to months of life-saving procedures during hospitalization in the neonatal intensive care unit, that appears to impact the HPA axis long after NICU discharge. Importantly, the neuroendocrine system, the immune system and the central nervous system are

Opioids are being over prescribed in the United States resulting in increased deaths by drug overdose. Pain medication strategies are being looked into as substitutes for pain management. Over decades, the amount of medicine being prescribed has more than tripled. State policies regarding the medication were implemented and who'd a small decrease in the likelihood of opioid prescriptions. Nationally, death rates are on the rise. Studies monitoring prescription drugs do not account for illegal opioids and manufactured fentanyl. While not mentioned in this article, there is a possible correlation between young people prescribed opioids and illegal drug use seeing that overdoses are common in patients already abusing their prescription medication, yet overdose death being most common after

“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.

Opioid abuse, misuse and overdose is a problem in The United States. You can’t turn on the TV or read a newspaper without some mention of the epidemic. This issue has caused the practice of prescribing or taking narcotic pain medication to be looked at under a microscope. Patients are fearful to use some necessary pain medication, because they may become addicted. Other patients who genuinely do have pain and need medication are having a tougher time obtaining the help they need. The problem of abuse and addiction is tough to solve since for some people the medications are the only way they can function and live a semi-normal life. A patient with pain may be hesitant to visit the doctor and

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).

Opioid analgesics are the widely prescribed medications for both non-cancer and cancer-related pain. Opioid dugs provide significant benefit for patients, when they used for their approved indications. However, opioids are also carries the risk of abuse, misuse and death. In 2009, more than 15,500 people died in the United States due to overdose of narcotic pain relievers. In order to combat the opioid misuse, abuse, and addiction, FDA has taken many steps to address this problem over the last few decades. The task force’s multi- pronged approach targets, drug development, opioid labeling, prescriber education, patient education, exploring innovative packaging and storage to prevent abuse, encouraging the development of products that treat abuse and overdose and role of other agencies.

The title slide and variables could have been explained in a way to let the reader know that neonatal outcome was being measured after exposure to treatment medication methadone and buprenorphine and not just "opioids."Mariah's presentation followed the grading rubric she did not over-crowd her slides, which made it an easy read. Overall, Mariah's presentation was informative.

The use of opioids during pregnancy has increased drastically over recent years, causing newborns to fall victim to the opioid crisis. It has now become an epidemic, affecting people in the United States and globally making it a major health concern. A vast percentage leading to the opioid crisis is due to women in their childbearing stages of life. Newborns born to women addicted to opioids suffer through a form of newborn drug withdrawal known as Neonatal abstinence syndrome (NAS), resulting in increased admission rates, prolonged length of stay in the hospital and infants often require medication to recover. NAS is a result of opioid exposure in utero characterized by “central nervous system hyperirritability and autonomic nervous system dysfunction” (Kraft et

(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

monitor fetal heartbeat. In the first stage of labor , the neck of the uterus,

Brain development in the first two years is the most important and critical. Maria Montessori referred to this time as of the "absorbent mind" Early brain development is the frame work for the road ahead. When and how the brain develops in the first two years will play a critical role into adulthood. At birth, the brain is the only incomplete organ. The brain will continue to grow through childhood and adolescents.