Download Risk Factors for Newborn of Substance Abusers

SUBSTANCE ABUSE &
NEWBORNS
Margaux Barlow, Jaclyn Engstrom,
Rasika Kulkarni, Hillary O’Kelly
Why is this important:
 5.5% of pregnant women in the United
States reported using at least one illicit drug
during pregnancy.
 21.2% of pregnant women aged 12-44
reported use of alcohol and 21.5% use of
cigarettes during the past month.
Impact on Mom’s Prenatal
Care/ Newborn Outcome
 Poor Nutrition
 Late Prenatal Care
 Greater risk for: infectious diseases &
Sexually transmitted diseases
 Limited financial resources
 Increased risk: premature
birth, abruptio placenta,
and fetal demise.
Impact on Baby
 60-90% of opiate
exposed infants develop
neonatal abstinence
syndrome (NAS).
 Symptoms will
 manifest within
 48 to 72 hours
after birth
S&S of Neonatal Abstinence
Syndrome
 Withdrawal
 Irritability
 Tremors
 High-pitched cry
 Diarrhea & Vomiting
 Respiratory Distress
 Abrasions
 Weight loss
 Aberrant temp control
 Lack of sucking
 Sneezing
Signs of Neonate Withdrawl
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Irritability
Tachypena
Tremors
Shrill Cry
Mottling
Hypertonicity of muscles
Frantic Sucking of hands
Temperature instability
Loose diarrheal stools
Seizures
Nasal stuffiness
 Sleep Disturbances
Which leads to:
“Unlovable Infant…
Baby Outcomes
 Guilt and Denial from the mother contribute
to a poor communication/ connection
between mom and baby
 Leads to impaired language development,
social-emotional problems, and/ or neglect
and abuse.
 Increased risk for medical, emotional/
behavior, and developmental difficulties.
Haven House and CAP
 Most drug treatment programs cater to male
clients
 Those who accept women will often rescind
treatment to women who become pregnant
while in program
 Provision of child-care for existing children is
also vital to most women… high risk of
relapse during immediate postpartum period.
 So….
Placenta
Pathophysiology of Fetal Alcohol Syndrome:
Symptoms of a baby with fetal alcohol
syndrome
 Poor growth while the baby is in the womb and after birth
 Decreased muscle tone and poor coordination
 Delayed development and significant functional problems
in three or more major areas: thinking, speech,
movement, or social skills (as expected for the baby's age)
 Heart defects such as ventricular septal defect (VSD) or
atrial septal defect (ASD)
Structural problems with the face, including:
 Narrow, small eyes with large epicanthal fold
 Small head
 Small upper jaw
 Smooth groove in upper lip
 Smooth and thin upper lip
Fetal Alcohol Syndrome
Fetal Alcohol Syndrome:
Tests
 Blood alcohol level in pregnant women who
show signs of being drunk (intoxicated)
 Brain imaging studies (CT or MRI) shows
abnormal brain development
 Pregnancy ultrasound shows slowed growth of
the fetus
 Toxicology screen
Cocaine Abusing Pregnant
Women
 Increase the risk of miscarriage
 When the drug is used late in pregnancy, it may trigger
premature labor
 It also may cause an unborn baby to die or to have a
stroke, which can result in irreversible brain damage
 More likely to have a low birth-weight baby
 More likely to have babies born with smaller heads and
smaller brains proportionate to body size
 Twice as likely to have a premature baby
 Placental abruption
 Baby with a malformation of the urinary tract
 Feeding difficulties and sleep disturbances in newborn
Smoking while Pregnant
 Lower the amount of oxygen available to you and
your growing baby
 Increase your baby's heart rate
 Increase the chances of miscarriage and stillbirth
 Increase the risk that your baby is born prematurely
and/or born with low birth weight
 Increase your baby's risk of developing
respiratory (lung) problems
 Elevates the risk of having a child with
excess, webbed or missing fingers and toes
CLINICAL SIGNS associated
with Opiate Withdrawal in
Newborns
 Central Nervous System Dysfunction
 Autonomic Dysfunction
 Respiratory Dysfunction
 Gastrointestinal Dysfunction
Risk Factors for Newborns of
Substance Abusers
 FEEDING PROBLEMS
Suck-swallow incoordination
Tongue thrust during feedings
Poor formula intake
Failure to thrive
 SLEEP
Sleep-wake cycles disorder
 ATTENTION
Difficulty with reactivity to stimuli
Risk Factors for Newborn of
Substance Abusers
 HYPERTONIC BABIES
 Also known as “stiff babies”
 Brief deep tendon reflexes
 Persistence of primitive infant reflexes
 IRRITABILITY
 Neurological fragility
 Difficulty managing day-to-day stimuli
 Jerky movements
Screening
 Every infant born to a substance abuser
should be evaluated for HIV infection.
 Signs of neonatal abstinence syndrome
 Small head size (brain size)
 Newborns who are underweight
 Stroke in the newborn
 Intestinal blood flow compromise (NEC)
 Positive drug screen in mother
REFERENCES
Albersheim, S. (1991). Newborn Patients of Mothers with Substance AbuseProviding proper
health care for mothers and their babies. Can Fam Physician.(37):1739–1746.
Bertrand J, Floyd LL, Weber MK. Guidelines for identifying and referring persons with fetal
alcohol syndrome. MMWR Recomm Rep. 2005 Oct 28;54(RR-11):1-14.
Gorski, Terence T. (2001). Cocaine use during pregnancy. Gorski-Cenaps Web Publications.
Retrieved on November 10, 2009.
http://www.tgorski.com/Prevention/cocaine_use_during_pregnancy.htm
Nazario, Brunilda MD. Smoking During Pregnancy, Retrieved November 10, 2009.
http://www.nlm.nih.gov/medlineplus/ency/article/000911.htm
Perinatal Substance Abuse. UCSF Children’s Hospital:
http://www.ucsfchildrenshospital.org/pdf/manuals/59_SubAbuse.pdf
Stoll BJ. Metabolic disturbances. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.
Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap
106.