Clinical Policy: Neonatal Abstinence Syndrome Guidelines Reference Number: CP.MP.86 Revision Log Date of Last Revision: 09/21
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Recognizing When a Child's Injury Or Illness Is Caused by Abuse
U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE U.S. Department of Justice Office of Justice Programs 810 Seventh Street NW. Washington, DC 20531 Eric H. Holder, Jr. Attorney General Karol V. Mason Assistant Attorney General Robert L. Listenbee Administrator Office of Juvenile Justice and Delinquency Prevention Office of Justice Programs Innovation • Partnerships • Safer Neighborhoods www.ojp.usdoj.gov Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance; the Bureau of Justice Statistics; the National Institute of Justice; the Office for Victims of Crime; and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering, and Tracking. Recognizing When a Child’s Injury or Illness Is Caused by Abuse PORTABLE GUIDE TO INVESTIGATING CHILD ABUSE NCJ 243908 JULY 2014 Contents Could This Be Child Abuse? ..............................................................................................1 Caretaker Assessment ......................................................................................................2 Injury Assessment ............................................................................................................4 Ruling Out a Natural Phenomenon or Medical Conditions -
Caring for the Infant with Neonatal Abstinence Syndrome (NAS)
Dandle•LION products provide supportive care for infants with NAS Caring for the Infant with Neonatal Abstinence Syndrome (NAS) According to the American Academy of Pediatrics (2012), nonpharmacologic care strategies should comprise the initial approach to therapy in treating Neonatal Abstinence Syndrome. NAS is a self-limiting condition where the primary goal of the care team is to decrease symptoms without extraneous pharmacological and medical intervention. Successful management of neonatal withdrawal symptoms rests on a foundation of supportive care for mother and infant, with active participation from a multi-disciplinary care team. Evidence- based strategies include providing a calm environment with decreased visual and auditory stimuli, promoting sleep for parents and infant, providing positive proprioceptive and tactile sensory input, and maximizing nutrition to promote weight gain. Ideally, infant and family remain together for the duration of the hospital stay in a quiet, protected environment with Therapeutic Positioning Skin Protection Therapeutic Touch Protective Environment medical and psychosocial support that continues beyond hospitalization. The DandleWRAP Stretch is Preventing diaper dermatitis is Infant massage provides babies Swaddled, immersion bathing designed to support irritable, hard- essential to promoting comfort in with a positive tactile experience promotes temperature stability to-console babies. The lightweight, babies with NAS. Frequent stooling that promotes proprioception and creates a relaxing and calm American Academy of Pediatrics (2017). Alternative treatment approach for neonatal Holmes, A., Atwood, E. Whalen, B. Beliveau, J., Jarvis, J., Matulis, J. & Ralston, S. (2016). abstinence syndrome may shorten hospital stay. AAP News. Accessed online September Rooming-in to treat neonatal abstinence syndrome: Improved family-centered care at lower moisture-wicking fabric reduces can change the pH of the baby’s and encourages development experience for irritable babies. -
Neonatal Abstinence Syndrome Guideline
Neonatal Abstinence Syndrome MENU Introduction Incidence and risk factors 1. Risk factors for illicit drug use 2. Risk factors for adverse pregnancy outcomes 3. Risk factors for neonatal abstinence syndrome Consequences 1. Tobacco 2. Alcohol 3. Amphetamines 4. Cocaine and derivatives 5. Marijuana 6. Opiates 7. Polydrug use Diagnosis 1. Drug use in pregnancy 2. Testing of newborns 3. Diagnosis of withdrawal Interventions 1. Antenatal care a. Treatment of pregnant users of illicit drugs b. Smoking in pregnancy c. Support from caregivers for pregnant women abusing drugs 2. Postnatal care 3. Pharmacological treatment a. Opioid withdrawal: MORPHINE REGIMEN b. Non-opioid CNS depressants: PHENOBARBITONE REGIMEN c. Management of the vomiting baby Discharge The Drug use in pregnancy team Infant protection issues Follow-Up Keypoints References Introduction: Pregnant women using drugs have the same anxieties and expectations as other pregnant women. All women using drugs are entitled to accurate information, and to be treated sensitively in a non-judgmental manner. Maternal illicit drug use is a risk factor for adverse pregnancy and neonatal outcomes including preterm birth. Infants born to mothers using illicit drugs (and alcohol and tobacco) are at risk of the toxic effects of the drugs both in-utero and ex-utero; adverse pregnancy and neonatal outcomes related to the poor socioeconomic situations and lifestyle factors associated with illicit drug use; neonatal drug withdrawal; and the subsequent poor outcomes of infants reared in a socioeconomically disadvantaged environment. The Report of the US Preventative Services Task Force 1996 1 and the monograph review by Bell and Lau 2 1995 are used as background for the content of this guideline. -
Neonatal Drug Withdrawal Abstract
Guidance for the Clinician in Rendering Pediatric Care CLINICAL REPORT Neonatal Drug Withdrawal Mark L. Hudak, MD, Rosemarie C. Tan, MD,, PhD, THE abstract COMMITTEE ON DRUGS, and THE COMMITTEE ON FETUS AND Maternal use of certain drugs during pregnancy can result in transient NEWBORN neonatal signs consistent with withdrawal or acute toxicity or cause KEY WORDS opioid, methadone, heroin, fentanyl, benzodiazepine, cocaine, sustained signs consistent with a lasting drug effect. In addition, hos- methamphetamine, SSRI, drug withdrawal, neonate, abstinence pitalized infants who are treated with opioids or benzodiazepines to syndrome provide analgesia or sedation may be at risk for manifesting signs ABBREVIATIONS of withdrawal. This statement updates information about the clinical CNS—central nervous system — presentation of infants exposed to intrauterine drugs and the thera- DTO diluted tincture of opium ECMO—extracorporeal membrane oxygenation peutic options for treatment of withdrawal and is expanded to include FDA—Food and Drug Administration evidence-based approaches to the management of the hospitalized in- 5-HIAA—5-hydroxyindoleacetic acid fant who requires weaning from analgesics or sedatives. Pediatrics ICD-9—International Classification of Diseases, Ninth Revision — – NAS neonatal abstinence syndrome 2012;129:e540 e560 SSRI—selective serotonin reuptake inhibitor INTRODUCTION This document is copyrighted and is property of the American fi Academy of Pediatrics and its Board of Directors. All authors Use and abuse of drugs, alcohol, and tobacco contribute signi cantly have filed conflict of interest statements with the American to the health burden of society. The 2009 National Survey on Drug Use Academy of Pediatrics. Any conflicts have been resolved through and Health reported that recent (within the past month) use of illicit a process approved by the Board of Directors. -
Finnegan Neonatal Abstinence Scoring System: Normal Values for First 3 Days and Weeks 5–6 in Non-Addicted Infantsadd 2802 524
RESEARCH REPORT doi:10.1111/j.1360-0443.2009.02802.x Finnegan neonatal abstinence scoring system: normal values for first 3 days and weeks 5–6 in non-addicted infantsadd_2802 524..528 Urs Zimmermann-Baer1,2, Ursula Nötzli1, Katharina Rentsch3 & Hans Ulrich Bucher1 Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Zurich, Switzerland,1 Division of Neonatology, Department of Pediatrics, Children’s Hospital, Kantonsspital Winterthur, Switzerland2 and Institute for Clinical Chemistry, University Hospital Zurich, Switzerland3 ABSTRACT Objective The neonatal abstinence scoring system proposed by Finnegan is used widely in neonatal units to initiate and to guide therapy in babies of opiate-dependent mothers. The purpose of this study was to assess the variability of the scores in newborns and infants not exposed to opiates during the first 3 days of life and during 3 consecutive days in weeks 5 or 6. Patients and methods Healthy neonates born after 34 completed weeks of gestation, whose parents denied opiate consumption and gave informed consent, were included in this observational study.Infants with signs or symptoms of disease or with feeding problems were excluded. A modified scoring system was used every 8 hours during 72 hours by trained nurses; 102 neonates were observed for the first 3 days of life and 26 neonates in weeks 5–6. A meconium sample and a urine sample at weeks 5–6 were stored from all infants to be analysed for drugs when the baby scored high. Given a non-Gaussian distribution the scores were represented as percentiles. Results During the first 3 days of life median scores remained stable at 2 but the variability increased, with the 95th percentile rising from 5.5 on day 1 to 7 on day 2. -
Clinical Update and Treatment of Lactation Insufficiency
Review Article Maternal Health CLINICAL UPDATE AND TREATMENT OF LACTATION INSUFFICIENCY ARSHIYA SULTANA* KHALEEQ UR RAHMAN** MANJULA S MS*** SUMMARY: Lactation is beneficial to mother’s health as well as provides specific nourishments, growth, and development to the baby. Hence, it is a nature’s precious gift for the infant; however, lactation insufficiency is one of the explanations mentioned most often by women throughout the world for the early discontinuation of breast- feeding and/or for the introduction of supplementary bottles. Globally, lactation insufficiency is a public health concern, as the use of breast milk substitutes increases the risk of morbidity and mortality among infants in developing countries, and these supplements are the most common cause of malnutrition. The incidence has been estimated to range from 23% to 63% during the first 4 months after delivery. The present article provides a literary search in English language of incidence, etiopathogensis, pathophysiology, clinical features, diagnosis, and current update on treatment of lactation insufficiency from different sources such as reference books, Medline, Pubmed, other Web sites, etc. Non-breast-fed infant are 14 times more likely to die due to diarrhea, 3 times more likely to die of respiratory infection, and twice as likely to die of other infections than an exclusively breast-fed child. Therefore, lactation insufficiency should be tackled in appropriate manner. Key words : Lactation insufficiency, lactation, galactagogue, breast-feeding INTRODUCTION Breast-feeding is advised becasue human milk is The synonyms of lactation insufficiency are as follows: species-specific nourishment for the baby, produces lactational inadequacy (1), breast milk insufficiency (2), optimum growth and development, and provides substantial lactation failure (3,4), mothers milk insufficiency (MMI) (2), protection from illness. -
SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment
Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children POLICY STATEMENT SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment TASK FORCE ON SUDDEN INFANT DEATH SYNDROME abstract KEY WORDS Despite a major decrease in the incidence of sudden infant death syn- SIDS, sudden infant death, infant mortality, sleep position, bed- sharing, tobacco, pacifier, immunization, bedding, sleep surface drome (SIDS) since the American Academy of Pediatrics (AAP) released ABBREVIATIONS its recommendation in 1992 that infants be placed for sleep in a non- SIDS—sudden infant death syndrome prone position, this decline has plateaued in recent years. Concur- SUID—sudden unexpected infant death rently, other causes of sudden unexpected infant death that occur AAP—American Academy of Pediatrics during sleep (sleep-related deaths), including suffocation, asphyxia, This document is copyrighted and is property of the American and entrapment, and ill-defined or unspecified causes of death have Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American increased in incidence, particularly since the AAP published its last Academy of Pediatrics. Any conflicts have been resolved through statement on SIDS in 2005. It has become increasingly important to a process approved by the Board of Directors. The American address these other causes of sleep-related infant death. Many of the Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of modifiable and nonmodifiable risk factors for SIDS and suffocation are this publication. -
Definitions of Child Abuse and Neglect
STATE STATUTES Current Through March 2019 WHAT’S INSIDE Defining child abuse or Definitions of Child neglect in State law Abuse and Neglect Standards for reporting Child abuse and neglect are defined by Federal Persons responsible for the child and State laws. At the State level, child abuse and neglect may be defined in both civil and criminal Exceptions statutes. This publication presents civil definitions that determine the grounds for intervention by Summaries of State laws State child protective agencies.1 At the Federal level, the Child Abuse Prevention and Treatment To find statute information for a Act (CAPTA) has defined child abuse and neglect particular State, as "any recent act or failure to act on the part go to of a parent or caregiver that results in death, https://www.childwelfare. serious physical or emotional harm, sexual abuse, gov/topics/systemwide/ or exploitation, or an act or failure to act that laws-policies/state/. presents an imminent risk of serious harm."2 1 States also may define child abuse and neglect in criminal statutes. These definitions provide the grounds for the arrest and prosecution of the offenders. 2 CAPTA Reauthorization Act of 2010 (P.L. 111-320), 42 U.S.C. § 5101, Note (§ 3). Children’s Bureau/ACYF/ACF/HHS 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov Definitions of Child Abuse and Neglect https://www.childwelfare.gov CAPTA defines sexual abuse as follows: and neglect in statute.5 States recognize the different types of abuse in their definitions, including physical abuse, The employment, use, persuasion, inducement, neglect, sexual abuse, and emotional abuse. -
Overcoming Breastfeeding Concerns- Part 2
9/21/2018 OVERCOMING BREASTFEEDING Presented by: CONCERNS- PART 2 Kary Johnson, IBCLC OVERVIEW • Pacifiers • Pumping • Low Milk Supply • Feeding Multiples • Supplementation • Discharge Guidelines PICTURE FROM HTTPS://WWW.ETSY.COM/LISTING/464346270/BREAST-ENCOURAGEMENT-CARD-BREASTFEEDING 1 9/21/2018 PACIFIERS Step 9: Counsel mothers on the use and risks of feeding bottles, teats and pacifiers. What does the AAP say? •NG/Gavage •“Mothers of healthy term infants should be instructed to use pacifiers at •Hypoglycemia infant nap or sleep time after breastfeeding is well established, at Infant approximately 3 go 4 weeks of age.” •Lab draws • “Pacifier use should be limited to specific medical situations. These include Pain •Circumcision uses for pain relief, as a calming agent, or as part of a structured program •Illness for enhancing oral motor function.” •Medications Maternal •PMAD • NICU: to organize suck, swallow, breathe pattern of premature infant (in addition to reasons above) (AAP, 2012) PACIFIERS Ask yourself…what is the reason for use? Management: • All effort should be made to prevent separation of mom & baby (i.e. newborn nursery) • Avoid overuse • Be careful to not incorrectly pacify infant hunger • Non-nutritive sucking on mother’s breast is a great alternative Overuse or misuse results in: • Decreased breastfeeding duration • Reduced milk supply • Dental issues, difficulty weaning, and use well into childhood 2 9/21/2018 BREAST PUMPING Reasons a mother may need to pump: • Nipple trauma • Low milk supply • Late preterm infants -
Simplification of the Finnegan Neonatal Abstinence Scoring System: Retrospective Study of Two Institutions in the USA
Open Access Research BMJ Open: first published as 10.1136/bmjopen-2017-016176 on 27 September 2017. Downloaded from Simplification of the Finnegan Neonatal Abstinence Scoring System: retrospective study of two institutions in the USA Enrique Gomez Pomar,1 Loretta P Finnegan,2 Lori Devlin,3 Henrietta Bada,1 Vanessa A Concina,1 Katrina T Ibonia,1 Philip M Westgate4 To cite: Gomez Pomar E, ABSTRACT Strengths and limitations of this study Finnegan LP, Devlin L, et al. Objective To develop a simplified Finnegan Neonatal Simplification of the Finnegan Abstinence Scoring System (sFNAS) that will highly ► A simplified scoring system (simplified Finnegan Neonatal Abstinence Scoring correlate with scores ≥8 and ≥12 in infants being System: retrospective Neonatal Abstinence Scoring System (sFNAS)) is assessed with the FNAS. study of two institutions proposed developed from a large data set and cross- Design, setting and participants This is a in the USA. BMJ Open validated using a database from another institution. retrospective analysis involving 367 patients admitted to 2017;7:e016176. doi:10.1136/ ► Cutoff values are provided for the sFNAS which two level IV neonatal intensive care units with a total of bmjopen-2017-016176 predict the cutoff value. 40 294 observations. Inclusion criteria included neonates ► The retrospective nature of our study requires ► Prepublication history for with gestational age ≥37 0/7 weeks, who are being this paper is available online. prospective validation of the inter-rater reliability of assessed for neonatal abstinence syndrome (NAS) using To view these files, please visit the sFNAS and also the clinical validity of this tool. -
Pediatric Respiratory Rates Age Rate (Breaths Per Minute)
Pediatric Respiratory Rates Age Rate (breaths per minute) Infant (birth–1 year) 30–60 Toddler (1–3 years) 24–40 Preschooler (3–6 years) 22–34 School-age (6–12 years) 18–30 Adolescent (12–18 years) 12–16 Pediatric Pulse Rates Age Low High Infant (birth–1 year) 100 160 Toddler (1–3 years) 90 150 Preschooler (3–6 years) 80 140 School-age (6–12 years) 70 120 Adolescent (12–18 years) 60 100 Pulse rates for a child who is sleeping may be 10 percent lower than the low rate listed. Low-Normal Pediatric Systolic Blood Pressure Age* Low Normal Infant (birth–1 year) greater than 60* Toddler (1–3 years) greater than 70* Preschooler (3–6 years) greater than 75 School-age (6–12 years) greater than 80 Adolescent (12–18 years) greater than 90 *Note: In infants and children aged three years or younger, the presence of a strong central pulse should be substituted for a blood pressure reading. Pediatric CUPS Assessment Category Assessment Actions Example Critical Absent airway, Perform rapid initial Severe traumatic injury breathing, or interventions and transport with respiratory arrest or circulation simultaneously cardiac arrest Unstable Compromised airway, Perform rapid initial Significant injury with breathing, or interventions and transport respiratory distress, circulation with simultaneously active bleeding, shock; altered mental status near-drowning; unresponsiveness Potentially Normal airway, Perform initial assessment Minor fractures; unstable breathing, circulation, with interventions; transport pedestrian struck by car and mental status BUT -
Practice Resource: CARE of the NEWBORN EXPOSED to SUBSTANCES DURING PREGNANCY
Care of the Newborn Exposed to Substances During Pregnancy Practice Resource for Health Care Providers November 2020 Practice Resource: CARE OF THE NEWBORN EXPOSED TO SUBSTANCES DURING PREGNANCY © 2020 Perinatal Services BC Suggested Citation: Perinatal Services BC. (November 2020). Care of the Newborn Exposed to Substances During Pregnancy: Instructional Manual. Vancouver, BC. All rights reserved. No part of this publication may be reproduced for commercial purposes without prior written permission from Perinatal Services BC. Requests for permission should be directed to: Perinatal Services BC Suite 260 1770 West 7th Avenue Vancouver, BC V6J 4Y6 T: 604-877-2121 F: 604-872-1987 [email protected] www.perinatalservicesbc.ca This manual was designed in partnership by UBC Faculty of Medicine’s Division of Continuing Professional Development (UBC CPD), Perinatal Services BC (PSBC), BC Women’s Hospital & Health Centre (BCW) and Fraser Health. Content in this manual was derived from module 3: Care of the newborn exposed to substances during pregnancy in the online module series, Perinatal Substance Use, available from https://ubccpd.ca/course/perinatal-substance-use Perinatal Services BC Care of the Newborn Exposed to Substances During Pregnancy ii Limitations of Scope Iatrogenic opioid withdrawal: Infants recovering from serious illness who received opioids and sedatives in the hospital may experience symptoms of withdrawal once the drug is discontinued or tapered too quickly. While these infants may benefit from the management strategies discussed in this module, the ESC Care Tool is intended for newborns with prenatal substance exposure. Language A note about gender and sexual orientation terminology: In this module, the terms pregnant women and pregnant individual are used.