Management

A thorough alcohol and drug history should be obtained from the expectant mother—and this should be corroborated by testing the urine of both mother and newborn for alcohol and other drugs. Newborns should be closely monitored for signs of withdrawal for a minimum of forty-eight to seventy-two hours, and longer when the mother has been on METHADONE-maintenance treatment. Since symptoms of withdrawal are nonspecific and may be confused with a variety of infections or metabolic disturbances, a search for concurrent illness to explain any symptoms is mandatory.

Most hospital nurseries use a standardized neonatal abstinence-syndrome scoring system. After the infant is born the hospital will monitor their sleep habits, temperature, and weight. The earliest withdrawal symptoms are treated by intravenous fluids, swaddling, holding, rocking, a low-stimulation environment, and small feedings of hyper-caloric formula—for weight gain. If symptoms continue or increase, medication may be initiated. Common medications include PAREGORIC (camphorated tincture of opium), or Phenobarbital for opioid withdrawal; PHENOBARBITAL or DIAZEPAM for alcohol withdrawal. Diazepam is also used to help with cocaine hyper excitability.

Interviewing the mother is essential in reviewing the anticipated home environment. Unfortunately, addicted babies are often at high risk for either abuse or neglect or both. Normal maternal-infant bonding is difficult in the case of an irritable poorly responding neonate and a mother dealing with the guilt, low self-esteem, poverty, inadequate housing, and an abusive or absent partner or parent, which often accompany her own drug addiction. A referral to child protection services may therefore be indicated.

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