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

2. 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 reported use of alcohol and 21.5% use of cigarettes during the past month.

4. 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.

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

6. 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

7. 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…

8. 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.

9. 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….

10. Placenta

11. 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

12. Fetal Alcohol Syndrome

14. 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

15. 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

16. 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

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

18. 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

19. 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

20. 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

21. 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 Oct 28;54(RR-11):1-14.
Gorski, Terence T. (2001). Cocaine use during pregnancy. Gorski-Cenaps Web Publications. Retrieved on November 10,
Nazario, Brunilda MD. Smoking During Pregnancy, Retrieved November 10,
Perinatal Substance Abuse. UCSF Children’s Hospital:
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.