if heroin right before coming in as soon as the baby is born you will see the baby withdraw vs a mom taking methadone babies still need to withdraw from methadone and it has a long half-life so the baby may not withdraw until the baby is six days old moms need to be comfortable to come clean to us as to what they have done substance wise because if you don’t know the mom is on methadone she isn’t here 6 days PP
so the baby is suffering withdraw at home alone; mom probably signed papers saying if she becomes pregnant the clinic she gets the methadone from is allowed to share info with her Dr we need to know what substances PT is using Begin 1-3 or 5-10 days after birth Type of drug Amount of drug Length of use Length of gestation NAS score, toxicology (urine, meconium, hair, umbilical cord send to lab and freeze when mom is in the hospital because if the baby begins to have withdraw symptoms you can test the warton’s jelly and see what substances were being used ) NAS: Symptoms CONT Toxicology send urine on mom and baby: You cannot lie to mom and say it is for an infection (but really do a toxicology), but the baby can get one done without telling mom because the state says they have to help the most vulnerable citizens and babies are vulnerable citizens the mom can be negative but the baby can be positive depends on the substance because narcotics go through the system rapidly (24 hrs) i.e. morphine through moms veins 3 days ago is gone, but if she was a coke user (also a narcotic) but anything mom uses goes to the baby and her screen can be negative, but babys is positive because the metabolites from the cocaine pass the placenta and got to the baby, so the babys kidney needs to process the cocaine, they pee into the BOW, and then they swallow the amniotic fluid, getting another dose of cocaine it is a CYCLE—there can be a disconnect with a negative test on a mom but positive on the baby; hospitals can send meconium samples down because it is a buildup of all the cellular contents the baby swallowed over months and months; hair screen it takes a lot of time to grow that hair so I can see what mom was using months ago
Every baby born at term gets this screen every 3 hours to look for withdraw s/s NOT FOR PREEMIES! It is used to score babies for disturbances of the CNS, metabolic, vasomotor, respiratory, and GI system; not all babies that get a score needs to be treated—low score=no treatment, High (8 or 9)=TREAT the baby is suffering and needs to be treated NAS: Typical Findings Excessive or high-pitched crying inconsolable Increased tone stiff Hyperactive reflexes tremors Sweating & fever R/T increased tone and moving a lot remember new borns don’t sweat, but these babies are sweating because they are moving a LOT NAS: Typical Findings CONT Tachypnea Excessive sucking, feeding issues need to suck, but don’t feed properly(don’t know what to do with it) Mottling Vomiting & diarrhea all babies can get diaper rash, but these baby have butts that look HORRIBLE R/T diarrhea NAS: Treatment
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- Fall '19