20.10 Spotlight Application

Baby Noah was born at 38 weeks’ gestation via spontaneous vaginal delivery to a 26-year-old mother, Sarah, who has a history of opioid use disorder. Sarah was on a methadone maintenance program throughout her pregnancy. At birth, Noah weighed 2,750 grams (6 lb. 1 oz.) and had Apgar scores of 7 at one minute and 9 at five minutes.

By six hours of life, Noah began exhibiting symptoms of neonatal abstinence syndrome (NAS), including excessive crying, irritability, tremors, poor feeding, and loose stools. He was admitted to the neonatal intensive care unit (NICU) for monitoring and management. The Neonatal Abstinence Scoring System (Finnegan Scale) was used to assess the severity of his withdrawal symptoms.

1. What is Neonatal Abstinence Syndrome (NAS), and what are its common causes?

NAS is a withdrawal syndrome in newborns caused by in utero exposure to opioids or other substances. It occurs when a baby is suddenly deprived of the drugs their mother used during pregnancy. Common causes include maternal use of opioids such as heroin, methadone, buprenorphine, or prescription painkillers.

2. What are the common signs and symptoms of NAS in a newborn?

• High-pitched crying and irritability
• Tremors and jitteriness
• Sleep disturbances
• Poor feeding and difficulty sucking
• Vomiting and diarrhea
• Hypertonia (increased muscle tone)
• Sweating and fever
• Nasal congestion and sneezing
• Seizures in severe cases

3. What nursing interventions are important in the care of an infant with NAS?

Nonpharmacologic Interventions:

• Swaddling the infant to provide comfort and reduce irritability
• Reducing environmental stimuli (dim lighting, minimizing noise)
• Offering frequent, small feedings with a high-calorie formula or breast milk if appropriate
• Encouraging skin-to-skin contact and bonding with the mother
• Using pacifiers to help with self-soothing

Pharmacologic Management (if needed):

• Administering medications such as morphine or methadone for severe withdrawal symptoms
• Titrating doses based on NAS scoring and gradually weaning

4. How is NAS diagnosed and assessed in neonates?

NAS is primarily diagnosed based on maternal history, clinical signs, and withdrawal scoring systems such as the Finnegan Neonatal Abstinence Scoring System. This tool evaluates multiple symptoms and assigns a numerical score to guide treatment decisions.

5. What are some potential long-term effects of NAS on infants?

• Developmental delays, including motor and cognitive challenges
• Behavioral issues such as hyperactivity and attention deficits
• Increased risk of sudden infant death syndrome (SIDS)
• Growth and feeding difficulties in infancy

6. How can nurses provide education and support to mothers with opioid use disorder?

• Encouraging maternal involvement in care and bonding with the infant
• Providing education on the benefits of breastfeeding if the mother is on a stable methadone or buprenorphine program
• Connecting the mother with social services, substance use counseling, and support groups
• Teaching safe sleep practices to reduce the risk of SIDS
• Addressing stigma and reinforcing positive reinforcement to support long-term recovery