SUBSTANCE ABUSE & NEWBORNS Margaux Barlow, Jaclyn Engstrom, Rasika Kulkarni, Hillary O’Kelly

Why is this important: 5.5% of pregnant women in the United States reported using at least one illicit drug during pregnancy. 21.2% of pregnant women aged 12-44 reported use of alcohol and 21.5% use of cigarettes during the past month.

Impact on Mom’s Prenatal Care/ Newborn Outcome Poor Nutrition Late Prenatal Care Greater risk for: infectious diseases & Sexually transmitted diseases Limited financial resources Increased risk: premature birth, abruptio placenta, and fetal demise.

Impact on Baby 60-90% of opiate exposed infants develop neonatal abstinence syndrome (NAS). Symptoms will manifest within 48 to 72 hours after birth

S&S of Neonatal Abstinence Syndrome Withdrawal Irritability Tremors High-pitched cry Diarrhea & Vomiting Respiratory Distress Abrasions Weight loss Aberrant temp control Lack of sucking Sneezing

Signs of Neonate Withdrawl Irritability Tachypena Tremors Shrill Cry Mottling Hypertonicity of muscles Frantic Sucking of hands Temperature instability Loose diarrheal stools Seizures Nasal stuffiness Sleep Disturbances Which leads to: “Unlovable Infant…

Baby Outcomes Guilt and Denial from the mother contribute to a poor communication/ connection between mom and baby Leads to impaired language development, social-emotional problems, and/ or neglect and abuse. Increased risk for medical, emotional/ behavior, and developmental difficulties.

Haven House and CAP Most drug treatment programs cater to male clients Those who accept women will often rescind treatment to women who become pregnant while in program Provision of child-care for existing children is also vital to most women… high risk of relapse during immediate postpartum period. So….

Placenta

Pathophysiology of Fetal Alcohol Syndrome: Symptoms of a baby with fetal alcohol syndrome Poor growth while the baby is in the womb and after birth Decreased muscle tone and poor coordination Delayed development and significant functional problems in three or more major areas: thinking, speech, movement, or social skills (as expected for the baby's age) Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD) Structural problems with the face, including: Narrow, small eyes with large epicanthal fold Small head Small upper jaw Smooth groove in upper lip Smooth and thin upper lip

Fetal Alcohol Syndrome

Fetal Alcohol Syndrome: Tests Blood alcohol level in pregnant women who show signs of being drunk (intoxicated) Brain imaging studies (CT or MRI) shows abnormal brain development Pregnancy ultrasound shows slowed growth of the fetus Toxicology screen

Cocaine Abusing Pregnant Women Increase the risk of miscarriage When the drug is used late in pregnancy, it may trigger premature labor It also may cause an unborn baby to die or to have a stroke, which can result in irreversible brain damage More likely to have a low birth-weight baby More likely to have babies born with smaller heads and smaller brains proportionate to body size Twice as likely to have a premature baby Placental abruption Baby with a malformation of the urinary tract Feeding difficulties and sleep disturbances in newborn

Smoking while Pregnant Lower the amount of oxygen available to you and your growing baby Increase your baby's heart rate Increase the chances of miscarriage and stillbirth Increase the risk that your baby is born prematurely and/or born with low birth weight Increase your baby's risk of developing respiratory (lung) problems Elevates the risk of having a child with excess, webbed or missing fingers and toes

CLINICAL SIGNS associated with Opiate Withdrawal in Newborns Central Nervous System Dysfunction Autonomic Dysfunction Respiratory Dysfunction Gastrointestinal Dysfunction

Risk Factors for Newborns of Substance Abusers FEEDING PROBLEMS Suck-swallow incoordination Tongue thrust during feedings Poor formula intake Failure to thrive SLEEP Sleep-wake cycles disorder ATTENTION Difficulty with reactivity to stimuli

Risk Factors for Newborn of Substance Abusers HYPERTONIC BABIES Also known as “stiff babies” Brief deep tendon reflexes Persistence of primitive infant reflexes IRRITABILITY Neurological fragility Difficulty managing day-to-day stimuli Jerky movements

Screening Every infant born to a substance abuser should be evaluated for HIV infection. Signs of neonatal abstinence syndrome Small head size (brain size) Newborns who are underweight Stroke in the newborn Intestinal blood flow compromise (NEC) Positive drug screen in mother

REFERENCES Albersheim, S. (1991). Newborn Patients of Mothers with Substance AbuseProviding proper health care for mothers and their babies. Can Fam Physician.(37):1739–1746. Bertrand J, Floyd LL, Weber MK. Guidelines for identifying and referring persons with fetal alcohol syndrome. MMWR Recomm Rep. 2005 Oct 28;54(RR-11):1-14. Gorski, Terence T. (2001). Cocaine use during pregnancy. Gorski-Cenaps Web Publications. Retrieved on November 10, 2009. http://www.tgorski.com/Prevention/cocaine_use_during_pregnancy.htm Nazario, Brunilda MD. Smoking During Pregnancy, Retrieved November 10, 2009. http://www.nlm.nih.gov/medlineplus/ency/article/000911.htm Perinatal Substance Abuse. UCSF Children’s Hospital: http://www.ucsfchildrenshospital.org/pdf/manuals/59_SubAbuse.pdf Stoll BJ. Metabolic disturbances. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 106.