Education Guide for Parentsand

Caregivers

Neonatal Abstinence Syndrome (NAS)

• NAS may present in a baby who is exposed to medication taken by the mother prior to birth

Withdrawal• NAS is the signs and symptoms of

withdrawal after birth.

• It can be severe if not accurately assessed and treated.

• Methadone and Subutex withdrawal may not be seen until 3-7 days after birth.

• The length of stay for the baby may vary from 10 days to several months.

Finnegan Scoring System

• A tool used to assess withdrawal symptoms in the baby.

• Based on the baby’s scores decisions will be made as to if or when the medication will start.

• Receiving medication is called replacement therapy.

• Morphine

• Methadone

Finnegan Scoring System

• The dose and medication used will depend on Finnegan Scores, weight, and the type of medication used during pregnancy.

• Medications are adjusted or weaned based on withdrawal signs.

• Every baby responds differently to the weaning process.

• Sometimes medication is stopped and may need to be restarted due to withdrawal signs.

Finnegan Scoring System(refer to actual tool)

• Contains 21 symptoms of withdrawal divided into 3 categories:

1.Central Nervous System Disturbances

2. Gastrointestinal Disturbances

3. Respiratory and Vasomotor Disturbances

Finnegan Scoring System

• Assessment is not of a single point in time, scores should reflect all the symptoms observed since the last scoring time.

• Observation by the healthcare worker and parents for symptoms is very important.

• The baby will be scored every 3 hours before feedings.

CNS Disturbances

• Excessive or high pitched cry

• Sleeplessness

• Excoriation

• skin breakdown on chin, knees, elbows, toes, or nose

• Jerks or tremors, jitteriness, irritability

CNS Supportive Measures

• Soothe baby with swaddling

• Talk/hum quietly

• Hold baby close to body

• Use infant swing/vibrating chair

• Reduce noise and lighting in room

• Skin to skin holding (kangaroo care)

• Use protective skin creams

• Handle baby with slow gentle movements

• Use infant massage or swaddle bath

Gastrointestinal Disturbances

• Excessive sucking- does not always mean they are hungry

• Poor feeding

• Vomiting

• Skin breakdown due to loose stool/diarrhea

• Gas pain

Gastrointestinal Supportive Measures

• Use pacifier/sweet ease

• Feed on 3 hour schedule (reduce noise during feeding)

• Use breast milk (may reduce the severity of the symptoms)

• Burp regularly

• Do not overfeed

• Change diaper often

Respiratory/VasomotorDisturbances

• Sweating

• Fever (temp >99)

• Nasal stuffiness/excessive nasal secretions

• Nasal flaring/fast breathing

• (> 60 bum)

• Yawning

• Sneezing

• Mottled color

Respiratory/Vasomotor Supportive Measures

• Do not overdress or over swaddle baby

• Use infant sleep sac

• Use gentle suction if nasal secretions cause blockage

Respiratory/VasomotorSupportive Measures

Safe Sleep• Back to Sleep

• Best position is on back, in sleep sac, in crib

• Infant swings/vibrating chairs may be utilized at intervals while parent is awake.

• Infant should never be left unattended on couch or chair.

• Infant should never sleep on couch or in chair with parent.

Thank You!• Parent presence is very important for early

response to withdrawal signs and calming the baby.

• We realize this is very tiring. We suggest parents take turns with care/feeding activities to allow themselves to rest. Also, break periods outside may help you refresh.

• Do not hesitate to ask for help from the staff. We are a team working together for the common goal of getting your baby home as quickly and safely as possible!