Neonatal abstinence syndrome is a huge problem of concern at a global level.
Life course perspective
NAS affects the infant in a long-term pattern. Starting with neurodevelopmental disorders. Very less has been discovered regarding the association between NAS and the neurodevelopmental delay but according to American psychiatric association NAS can cause intellectual disabilities, disorders related to communication and learning, ADHD, autism spectrum disorder and hyperactivity disorder. (Shearer et al., 2018). A study was done in Tennessee which suggests that NAS babies were comparatively more likely to have a subsequent educational disability. (Mary-Margaret et al., 2011). Another study done in south western border state suggests that NAS babies were more prone to having LBW, respiratory distress and feeding difficulties compared to other newborns (Hussaini & Garcia, 2018).
Assessment of NAS
Infants suffering from NAS are usually assessed using a scoring system called as Finnegan scoring system. It is the most widely accepted measurement for opioid withdrawal. (Timpson et al., 2018). The initial scoring is done during the first hour then it is repeated after every 3-4 hours. This is repeated until 72 hours and if the infant has a history of long-term exposure then it has to be continued for 120 hrs. This scoring system is also used to check the effectiveness of the treatment (Hussaini & Garcia, 2018).
Usually the mother reports herself about the opioid usage, but some physicians often use urine toxicology screening for the suspected drug abuse. The result is useful to know the exact drug that was consumed so to plan the treatment strategy accordingly. The validity of the toxicology test is still a debatable topic. Also, the maternal consent is extremely important before performing any toxicology screening.
Management of infants having NAS depends on various factors like creating a proper physical environment for the infant, having well trained health care team, providing correct medication according to the schedule and using proper assessment tools to check for the improvement and the effectiveness of the treatment. The main treatment goal is to restore the normal activities of the infant like sleeping pattern, weight gain, feeding and swallowing and also protect the infant from the possible complications of NAS.
The management of NAS babies can be divided into two main categories- pharmacological interventions and non-pharmacological.
The first step is creating suitable physical environment for the babies. Recent researches support rooming in that is keeping opioid dependent mother and the infant in same room from birth itself. This kind of practice has various additional benefits like shorter hospital stay, more breastfeeding sessions and lesser NICU admissions. Rooming in is considered over NICU admissions in cases when the infant is born after full term or is completely stable and out of risk. Some of the interventions followed are skin to skin contact, very quiet environment and gentle swaddling. Breast feeding is considered extremely important as it helps to delay the onset of NAS and also helps to decrease the severity of complications (Noah et al., 2018). All the opioid dependent mothers should be encouraged to breastfeed their child, it helps in maternal infant attachment and to enhance normal growth.
Impaired feeding behavior is another remarkable problem in NAS babies. They often tend to reject the nipple, hiccough continuously, spit up or cough. Supplementation can be given to such babies to improve the caloric intake.
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