Neonatal Abstinence Syndrome
Risks for developing NAS Opioids – Opiate derivatives, interact with mu-opioid receptor Abstinence syndrome (withdrawal) experienced following variable length of repeated exposure
Risks for developing NAS “Narcotics” – Definition Cocaine PCP Stimulants – Amphetamine and derivatives Methamphetamine Amphetamine MDMA Many others
Risks for developing NAS Other possible culprits? – SSRI/SNRI – marijuana – Caffeine – Tobacco – Alcohol – Everything else we “should not use”
Risks for developing NAS When does it happen – Immediately – hours – Weeks – Never
Risks for developing NAS Breastfeeding Co-morbidities – HIV – Hep B, Hep C
Consequences of NAS Seizures Temperature instability Poor feeding Hypoglycemia Inadequate Sleep
Recognizing NAS Neonatal abstinence scales – Most commonly used is Finnegan – Several others avaiable – Positive screen threshold is 8 – Score of 24 on any 2 or 3 scores leads to intervention
Finnegan NAS scoring tool (handout) Example cases discussed with audience Practice with examples to determine score Will complete several scorings, discuss ease of use of the tool
Therapy for NAS Ideally, replace the substance that is suddenly missing Slowly reduce the exposure over time
Therapy for NAS Alternatively substitute another similar substance – Safety – Availablilty – Efficacy for symptom control
Therapy for NAS Possible approaches – Replacement Chronic pain syndromes Continue to use original or similar substance Morphine – Substitution Illicit use of schedule I substances Heroin – Use another mu opioid » Methadone » Burpenorphine +/- Naloxone » Morphine
Therapy for NAS Possible approaches – Symptom Relief Tylenol Clonidine Phenobarbitol (barbiturate)
Therapy for NAS Symptom Relief – Antihistamines – Restraint
Therapy for NAS – Substitution (same class) Illicit use of schedule I substances Heroin – Use another mu opioid » Methadone » Burpenorphine +/- Naloxone » Morphine
Therapy for NAS – Substitution (different class) Phenobarbitol Clonidine
Prevention Methadone – Lower dose? » No change in rate Buprenorphine Naloxone Fentanyl, MS-Contin (morphine) SSRI