patty zetterberg, msn, c-pnp director, clinical operations medical practice management east...
TRANSCRIPT
Patt y Zett erberg, MSN, C-PNPDirector, C l in ica l Operati ons
Medica l Practi ce Management
East Tennessee Chi ldren’s Hospita l
Neonatal Abstinence Syndromeand Long-Term Effects of Intrauterine Drug Exposure
Tolerance – Dependence – Addiction
ToleranceOur body develops tolerance to a drug’s effect so that an increased amount of drug is required to produce effect. DependenceIf the supply of the drug is removed then the person will exhibit “withdrawal symptoms”. AddictionThe continuing, compulsive nature of the drug use despite physical and/or psychological harm to the user and society.
What Problems Does NAS Cause?
AT BIRTH•Increased risk of preterm birth•Low birth weight•CNS (Central Nervous System): irritability•Musculoskeletal: agitation, tremors, increased tone (stiffening)•Respiratory: nasal congestion, increased respiratory rate•GI (Gastrointestinal): emesis (vomiting), reflux, diarrhea
Typical Course of TreatmentMedication
60 % of NAS babies•Morphine only•LOS 20 days
35% of NAS babies•Require adjunctive meds• Phenobarbital (15%)• Clonidine (9%)• Phenobarbital + Clonidine (11%)
•LOS 28 days• Longest LOS = 155 days
5% of NAS babies LOS 31 days
MedicationPositioning, comfort measuresFormula changes for refluxRooming-InHome…follow-up appointments
Typical Course of Treatment
LONG-TERM EFFECTS•Sleep Regulation•Mood/Behavior Regulation•Attention Regulation•Sensory Regulation•Pain Management Regulation
SleepBrain opiate receptors and onset/regulation of sleep
“Quiet sleep” significantly reduced, even 4-5 weeks after NAS treatment finished
Toddler sleep
Behavior RegulationEmotional reactivity
Lack of self-regulationRule-breakingAggression
Increase in oppositional defiant disorder
Attention RegulationDecreased “executive functioning”
Attention: decreased sustained attention, decreased selective attention
Impulse controlAggression
Decreased perceptual reasoning (envision solutions to non-verbal problems)Decreased information processingDecreased decision-making
Sensory Processing Regulation5 Senses
Processing Issue
Touch Me/Touch Me Not
Pain Management Regulation
???
Psychosocial Implications Biological Family
Increased risk of neglect/abuse in addicted households20% increase in maltreatment in cocaine-exposed
infants with biological parents 60-90% of drug addicts may have mental, emotional or
personality disorders, leading to poor parenting skills
Long Term Effects Nicotine Alcohol Marijuana Opiates Cocaine Metham-phetamine
Growth No consensus on effect
Strong effect
No effect No effect No consensus on effect
Unknown
Behavior Effect Strong effect
Effect Effect Effect Unknown
Cognition Effect Strong Effect
Effect No consensus on effect
Effect Unknown
Language Effect Effect No effect Unknown Effect Unknown
Achievement Effect Strong Effect
Effect Unknown No consensus on effect
Unknown
Summary of Effects of Intrauterine Drug Exposure
(Behnke, 2013)
Questions?