ATI Newborn Complications
Neonatal substance withdrawal
Maternal substance use during pregnancy consists of any use of alcohol or drugs.
Intrauterine drug exposure can cause anomalies, neurobehavioral changes, and evidence of withdrawal in
the neonate.
These changes depend on the specific drug or combination of drugs used, dosage, route of
administration, metabolism and excretion by the mother and fetus, timing of drug exposure, and length of
drug exposure.
Which medications would mother use for neonatal substance withdrawal occur?
Substance withdrawal in the newborn occurs when the mother uses drugs that have addictive properties during
pregnancy.
This includes illegal drugs, alcohol, tobacco, and prescription medications.
Neonatal substance withdrawal
Maternal substance use during pregnancy consists of any use of alcohol or drugs.
Intrauterine drug exposure can cause anomalies, neurobehavioral changes, and evidence of
withdrawal in the neonate.
These changes depend on the specific drug or combination of drugs used, dosage, route of
administration, metabolism and excretion by the mother and fetus, timing of drug exposure, and
length of drug exposure.
Which medications would mother use for neonatal substance withdrawal occur?
Substance withdrawal in the newborn occurs when the
mother uses drugs that have addictive properties during
pregnancy.
This includes illegal drugs, alcohol, tobacco, and prescription medications.
Fetal alcohol syndrome (FAS)
Results from the chronic or periodic intake of alcohol during pregnancy.
,Alcohol is considered teratogenic, so the daily intake of alcohol increases the risk of FAS.
Newborns who have FAS are at risk for specific congenital physical defects and long-term
complications.
Neonatal substance withdrawal: Long term Complications
● Feeding problems
● CNS dysfunction (cognitive impairment, cerebral palsy)
● Attention deficit disorder
● Language abnormalities
● Microcephaly
● Delayed growth and development
● Poor maternal-newborn bonding
Neonatal substance withdrawal: Risk Factors
● Maternal use of substances prior to knowing she
is pregnant
● Maternal substance use during pregnancy
Neonatal substance withdrawal: Expected Findings
Monitor the neonate for abstinence syndrome (withdrawal) and increased wakefulness using the
neonatal abstinence scoring system that assesses for and scores the following.
● CNS: High-pitched, shrill cry; incessant crying;
irritability; tremors; hyperactivity with an increased
Moro reflex; increased deep-tendon reflexes; increased
muscle tone; disturbed sleep pattern; hypertonicity;
convulsions
● Metabolic, vasomotor, and respiratory findings: Nasal
congestion with flaring, frequent yawning, skin mottling,
retractions, apnea, tachypnea greater than 60/min,
sweating, temperature greater than 37.2° C (99° F)
● Gastrointestinal: Poor feeding; regurgitation (projectile vomiting); diarrhea; excessive,
uncoordinated, constant sucking
Opiate Withdrawl: Expected findings
Manifestations of neonatal abstinence syndrome
Heroin Withdrawl: Expected findings
● Low birth weight
● Small for gestational age (SGA)
● Manifestations of neonatal abstinence syndrome
● Increased risk of sudden infant death syndrome (SIDS)
Methadone Withdrawl: Expected findings
Manifestations of neonatal abstinence syndrome:
Increased incidence of seizures,
sleep pattern disturbances,
higher birth weights (compared to with heroin exposure)
, Marijuana Withdrawl: Expected findings
● Preterm birth, meconium staining
● Long-term effects, such as deficits in attention, cognition, memory, and motor skills
Amphetamine Withdrawl: Expected findings
Preterm or SGA,
drowsiness, jitteriness, sleep pattern disturbances,
respiratory distress,
frequent infections,
poor weight gain,
emotional disturbances,
and delayed growth and development
Alcohol Withdrawal: Expected findings
Jitteriness, irritability,
increased tone and reflex responses,
and seizures
Fetal Alcohol Syndrome: Expected findings
● Facial anomalies: small eyes, flat midface, smooth philtrum, thin upper lip, eyes with a wide spaced
appearance, epicanthal folds, strabismus, ptosis, poor suck, small teeth, and cleft lip or palate
● Deafness
● Abnormal palmar creases and irregular hair
● Many vital organ anomalies, such as heart defects, including atrial and ventricular septal defects,
tetralogy of Fallot, and patent ductus arteriosus
● Developmental delays and neurologic abnormalities
● Prenatal and postnatal growth delays
● Sleep disturbances
Tobacco use: Expected findings
Prematurity, low birth weight,
increased risk for SIDS,
increased risk for bronchitis, pneumonia,
and developmental delays
Neonatal substance withdrawal: Lab tests
Blood tests should be done to differentiate between neonatal drug withdrawal and CNS disorders.
● CBC
● Blood glucose
● Electrolyte imbalance
● Thyroid-stimulating hormone, thyroxine, triiodothyronine
● Drug screen of urine or meconium to reveal the substance used by the mother
● Hair analysis
Diagnostic test for Fetal Alcohol Syndrome
Chest x-ray for FAS to rule out congenital heart defects
Neonatal substance withdrawal: Nursing Care
Nursing care for maternal substance use and neonatal effects or withdrawal include the following in
addition to normal newborn care.
● Perform ongoing assessment of the newborn using the neonatal abstinence scoring system
assessment, as RX'ed.
● Elicit and assess the newborn's reflexes.
● Monitor the newborn's ability to feed and digest intake.
Neonatal substance withdrawal
Maternal substance use during pregnancy consists of any use of alcohol or drugs.
Intrauterine drug exposure can cause anomalies, neurobehavioral changes, and evidence of withdrawal in
the neonate.
These changes depend on the specific drug or combination of drugs used, dosage, route of
administration, metabolism and excretion by the mother and fetus, timing of drug exposure, and length of
drug exposure.
Which medications would mother use for neonatal substance withdrawal occur?
Substance withdrawal in the newborn occurs when the mother uses drugs that have addictive properties during
pregnancy.
This includes illegal drugs, alcohol, tobacco, and prescription medications.
Neonatal substance withdrawal
Maternal substance use during pregnancy consists of any use of alcohol or drugs.
Intrauterine drug exposure can cause anomalies, neurobehavioral changes, and evidence of
withdrawal in the neonate.
These changes depend on the specific drug or combination of drugs used, dosage, route of
administration, metabolism and excretion by the mother and fetus, timing of drug exposure, and
length of drug exposure.
Which medications would mother use for neonatal substance withdrawal occur?
Substance withdrawal in the newborn occurs when the
mother uses drugs that have addictive properties during
pregnancy.
This includes illegal drugs, alcohol, tobacco, and prescription medications.
Fetal alcohol syndrome (FAS)
Results from the chronic or periodic intake of alcohol during pregnancy.
,Alcohol is considered teratogenic, so the daily intake of alcohol increases the risk of FAS.
Newborns who have FAS are at risk for specific congenital physical defects and long-term
complications.
Neonatal substance withdrawal: Long term Complications
● Feeding problems
● CNS dysfunction (cognitive impairment, cerebral palsy)
● Attention deficit disorder
● Language abnormalities
● Microcephaly
● Delayed growth and development
● Poor maternal-newborn bonding
Neonatal substance withdrawal: Risk Factors
● Maternal use of substances prior to knowing she
is pregnant
● Maternal substance use during pregnancy
Neonatal substance withdrawal: Expected Findings
Monitor the neonate for abstinence syndrome (withdrawal) and increased wakefulness using the
neonatal abstinence scoring system that assesses for and scores the following.
● CNS: High-pitched, shrill cry; incessant crying;
irritability; tremors; hyperactivity with an increased
Moro reflex; increased deep-tendon reflexes; increased
muscle tone; disturbed sleep pattern; hypertonicity;
convulsions
● Metabolic, vasomotor, and respiratory findings: Nasal
congestion with flaring, frequent yawning, skin mottling,
retractions, apnea, tachypnea greater than 60/min,
sweating, temperature greater than 37.2° C (99° F)
● Gastrointestinal: Poor feeding; regurgitation (projectile vomiting); diarrhea; excessive,
uncoordinated, constant sucking
Opiate Withdrawl: Expected findings
Manifestations of neonatal abstinence syndrome
Heroin Withdrawl: Expected findings
● Low birth weight
● Small for gestational age (SGA)
● Manifestations of neonatal abstinence syndrome
● Increased risk of sudden infant death syndrome (SIDS)
Methadone Withdrawl: Expected findings
Manifestations of neonatal abstinence syndrome:
Increased incidence of seizures,
sleep pattern disturbances,
higher birth weights (compared to with heroin exposure)
, Marijuana Withdrawl: Expected findings
● Preterm birth, meconium staining
● Long-term effects, such as deficits in attention, cognition, memory, and motor skills
Amphetamine Withdrawl: Expected findings
Preterm or SGA,
drowsiness, jitteriness, sleep pattern disturbances,
respiratory distress,
frequent infections,
poor weight gain,
emotional disturbances,
and delayed growth and development
Alcohol Withdrawal: Expected findings
Jitteriness, irritability,
increased tone and reflex responses,
and seizures
Fetal Alcohol Syndrome: Expected findings
● Facial anomalies: small eyes, flat midface, smooth philtrum, thin upper lip, eyes with a wide spaced
appearance, epicanthal folds, strabismus, ptosis, poor suck, small teeth, and cleft lip or palate
● Deafness
● Abnormal palmar creases and irregular hair
● Many vital organ anomalies, such as heart defects, including atrial and ventricular septal defects,
tetralogy of Fallot, and patent ductus arteriosus
● Developmental delays and neurologic abnormalities
● Prenatal and postnatal growth delays
● Sleep disturbances
Tobacco use: Expected findings
Prematurity, low birth weight,
increased risk for SIDS,
increased risk for bronchitis, pneumonia,
and developmental delays
Neonatal substance withdrawal: Lab tests
Blood tests should be done to differentiate between neonatal drug withdrawal and CNS disorders.
● CBC
● Blood glucose
● Electrolyte imbalance
● Thyroid-stimulating hormone, thyroxine, triiodothyronine
● Drug screen of urine or meconium to reveal the substance used by the mother
● Hair analysis
Diagnostic test for Fetal Alcohol Syndrome
Chest x-ray for FAS to rule out congenital heart defects
Neonatal substance withdrawal: Nursing Care
Nursing care for maternal substance use and neonatal effects or withdrawal include the following in
addition to normal newborn care.
● Perform ongoing assessment of the newborn using the neonatal abstinence scoring system
assessment, as RX'ed.
● Elicit and assess the newborn's reflexes.
● Monitor the newborn's ability to feed and digest intake.
