Pharmacological therapy is used for babies with very severe case of withdrawal or in those babies whose NAS score keeps on increasing even after giving non-pharmacological treatment. This babies also need NICU admission for continues observation and check the improvement level while the therapy is going on. Infant can be shifted into parents care and rooming in can be started once the NAS score decreases.
Methadone, it is one of the long acting agonists. The main role of methadone is to occupy the receptor sites in brain that are affected by opioids and heroin. So, in turn it blocks the euphoria and the sedating effects of opioids and is also useful in relieving various other symptoms that occur because of withdrawal. It is not a cure, but it helps to correct the withdrawal. The methadone maintenance treatment model is considered the most successful model for the treatment of NAS (Nayeri et al., 2017).
Buprenorphine is another drug widely used for the treatment of NAS. It is a partial agonist and it also occupies the same receptors in brain cell like methadone. The main advantage of using Buprenorphine is it is a partial agonist, so it causes minimal withdrawal when it is stopped (Bryan, 2018). Several studies have shown that it has lesser side effect and it is associated with shorter hospital stay compared to methadone. In 2003 states were directed to implement policies and procedures for reporting NAS babies to CPS agencies by child abuse and prevention treatment act. It was made mandatory by this law that the state CPS agency develops safe recovery plans for NAS babies.
Florida follows Comprehensive addiction and recovery act. It suggests that a plan of safe care Is required to address the needs of both the infant and family. Complete data has to be reported by state i.e. number of infants affected and number of children for whom plan was given (Weiland et al., 2017).
What can be done?
According to CDC 2016 Guidelines for prescribing opioids for chronic pain the clinicians should prescribe the opioid with great sensitivity, clinician should discuss how long-term use will affect the present or future pregnancies and why to avoid pregnancy while taking opioids. A joint decision should be made between the patient and the clinician about taking opioids after looking at the pros and cons of it. According to FDA, a black box warning is compulsory on a box of opioid suggesting how harmful it is for pregnant ladies. Prescription drug monitoring program is extremely helpful to keep an eye on overuse of opioids. CDC ‘s policy of treating the two that is safer medication use in pregnancy is considered very helpful in the prevention of NAS at global level. Also, the National Preconception health and healthcare initiative helps the patients and family to gain proper knowledge related to improving preconception health (Ko et al., 2017).
The substance abuse and mental health service administration and the American college of Obgy recommends all the women who are suffering from opioid overuse and pregnant should receive MAT with methadone or buprenorphine.
Prenatal identification is very important. Counselling should be started in prenatal period itself of the mothers who are exposed to opioids. Obstetricians, pediatricians etc. should be involved in the discussion. Support for such mothers must be increased, the understanding of the staff should be increased that it is a chronic illness and they should be trained to care in nonjudgmental way. Provide proper training to medical staff on learning how to use scoring tools like Finnegan score properly. Increase the use of non-pharmacological approach and also involving mother and father in the treatment process, encourage breastfeeding and rooming in. Discharge should be planned properly. Families should be involved and trained to take care of baby after discharge. Primary prevention should be done. Knowledge should be given regarding opioid overuse to pregnant ladies and also those in preconception phase. Importance should be given to follow up after discharge, Neurodevelopmental examination is essential check any cognitive delays. Ophthalmic assessment has to be done for any visual defects. Nutrition level should be regularly monitored to check proper growth of the child, psychiatric assessment to check about hyperactivity or ADHD.
NAS can be completely prevented if proper care is taken and if the correct amount of knowledge is given. More policies must be developed, and researches should be done for treatment.
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