Furthermore, every 25 minutes an infant is born with NAS (Centers for Disease Prevention and Management, 2017). Contributing to the rising numbers of infants born with neonatal abstinence syndrome are the ever-increasing rates of individuals abusing drugs and alcohol while pregnant (Wiles, Isemann, Ward, Vinks, & Akinbi, 2014). Therefore, it has become extremely important for nurses working within this population to educate themselves both on the signs and symptoms of NAS, as well as treatments. The incidence of NAS has tripled nationally, affecting 47-57% of infants born to mothers on methadone or buprenorphine maintenance therapy (Wiles et al., 2014).
There are several additional factors that impact a baby born with NAS. These risk factors may include a lack of prenatal care, premature delivery, sexually transmitted infections, Hepatitis C virus, human immunodeficiency virus (HIV), cigarette smoking, fetal intrauterine growth restriction, and poor maternal nutritional status (Wiles et al., 2014). Neonatal babies experience immediate effects of withdrawals once born. These immediate effects can be neurological, gastrointestinal, autonomic signs, respiratory distress, and skin excoriation (Winkelman et al., 2018). These immediate effects are seen evident in the video titled Incidence and Cost of Neonatal Abstinence Syndrome is Rising (Winkelman et al., 2018). The neurological excitability symptoms comprise of tremors, irritability, increased muscle tone, and seizures (Wiles et al., 2014). Gastrointestinal dysfunction encompasses feeding difficulties, vomiting, poor weight gain (Wiles et al., 2014). The autonomic signs that NAS babies may experience include diaphoresis, nasal stiffness, mottling, as well as temperature instability (Wiles et al., 2014). According to Wiles et al., there has also been evidence of long term effects for those born with NAS. Researchers have noted an increased risk of readmission to the hospital during the first five years of a child’s life (Wiles et al., 2014).
In addition to an increased prevalence of NAS, cost of neonatal abstinence syndrome has been on the rise. Medicaid is the primary payer of the NAS births and hospital stays. In fact, Medicaid paid for approximately 73.7% of NAS births in the year 2004 (Winkelman et al., 2018). Then, in 2014, 82% of NAS births were paid for by Medicaid (Winkelman et al., 2018). In 2011, in the state of Ohio alone, approximately $70 million was spent on the treatment of NAS within the hospital setting (Witt, C. E., Rudd, K. E., Rivara, P. F., Hawes, S. E., & Weiss, N. S., 2017). Other hospital costs which are paid for by Medicaid include testing for drug use in pregnant women. Urine, meconium and umbilical cord tissue are the three main methods of testing in these situations (Wiles et al., 2014). Although each of these tests are similar in price, costing $300-550, $250-500, and $400-800, they are crucial in the primary detection of detecting the potential of NAS early on (Wiles et al., 2014).
In light of the rising number of cases regarding NAS, nurses are being required to update their knowledge on the effects and treatments of drug and alcohol withdrawal in neonates. It is imperative that healthcare professionals keep up with the demands this condition continues to present. Nurses working in the area of maternal-fetal care must familiarize themselves with the early clinical signs of neonatal abstinence syndrome to promote the best possible outcome for newborns. Suffering from symptoms such as hypersensitivity to stimuli, tremors, respiratory distress, impaired growth and development, many vital organ anomalies, and more, neonates within this population need intensive nursing care (Sommer et al., 2013). Nursing considerations might include more frequent assessments, reducing external stimulation as much as possible, specialized pharmacologic interventions, interventions focused on prevention of vomiting and aspiration, the use of swaddling to reduce self-stimulation, and initiation of consultation with lactation and child protective services when necessary (Sommer et al., 2013). Additionally, more research is needed to determine the long-term effects this condition will have on the neonatal population. All of these components come together to affect the care of this vulnerable and growing population.
References
Centers for Disease Control and Prevention. (2017, August 01). Morbidity and Mortality Weekly Report (MMWR). Retrieved from https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm
Sommer, S., Johnson, J., Roberts, K., Redding, S., Churchill, L. (2013). RN Maternal Newborn Nursing (RN edition 9.0). Assessment Technologies Institute, LLC.
Stanford Children’s Health. (2016). Neonatal abstinence syndrome. Retrieved from: http://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387
Wiles, J. R., Isemann, B., Ward, L. P., Vinks, A. A., & Akinbi, H. (2014). Current Management of Neonatal Abstinence Syndrome Secondary to Intrauterine Opioid Exposure. The Journal of Pediatrics, 165(3), 440–446. http://doi.org/10.1016/j.jpeds.2014.05.010
Winkelman, T. N., Villapiano, N., Kozhimannil, K. B., Davis, N. M., Patrick, S. W., Incidence and Cost of Neonatal abstinence syndrome among infants with Medicaid: 2004-2014, Pediatrics Published Online: March 23, 2018 (doi:10.1542/peds.2017-3420). Funded by NIDA K23DA03720.
Witt, C. E., Rudd, K. E., Rivara, P. F., Hawes, S. E., & Weiss, N. S. (2017). Neonatal abstinence syndrome and early childhood morbidity and mortality in Washington state: a retrospective cohort study. Retrieved From https://www.nature.com/articles/jp2017106
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