THE INFANT OF AN ADDICTED MOTHER
Although abuse of alcohol, heroin, and marijuana has remained relatively stable, cocaine and crack use is
growing dramatically, affecting approximately 1 in 10 pregnancies (higher in urban areas). In addition to alcohol and
illicit drugs, abuse of prescription medications also occurs and use of multiple substances is common. From 80%–90%
of infants born to addicted mothers are physiologically addicted and experience passive signs of drug withdrawal,
commonly referred to as neonatal withdrawal syndrome or neonatal abstinence syndrome. It is estimated that cocaine
use alone impacts 30,000–50,000 infants born annually. An additional 3000–5000 infants yearly are determined to be
suffering from FAS. This plan of care is to be used in conjunction with the previous newborn plans of care. Refer also
to CPs: The Preterm Infant and Deviations in Growth Patterns, as appropriate.
NEONATAL ASSESSMENT DATA BASE
Severity and time of onset of symptoms are related to substance(s) abused, duration of use, and maternal drug level at
High-pitched cry, wakefulness, short or unquiet sleep patterns, yawning
Difficulty maintaining alert states
Poor state organization (cocaine use)
Hyperactive bowel sounds (hypermotility)
May be LBW or SGA infant; may have IUGR (maternal use of heroin, alcohol, or cocaine, or maternal malnutrition);
or may be higher-birth-weight/LGA infant (maternal use of methadone)
Poor feeding with uncoordinated frantic sucking, hyperphagia, drooling, hiccups, possible cleft lip
Weight decrease or failure to gain weight
Dry mucous membranes, poor skin turgor, sunken fontanels
Abdominal distension, changes in bowel sounds, dilation of bowel (paralytic ileus, NEC)
Apgar score may be low (e.g., intrauterine asphyxia or medication given to mother during intrapartal period).
Small head circumference/SGA (nicotine); microcephaly (FAS, cocaine use, toxic vapor abuse); facial abnormalities
(FAS, toxic vapor abuse).
Hyperirritability (including increased startle response), hyperactivity, poor state organization; hypertonicity may be
Hyperacusis (abnormal sensitivity to sound), difficulty attending to/actively engaging in auditory and visual stimuli.
Tremors, persistent or rhythmic myoclonic jerks, or seizure activity may be noted.