This refers to an infant who is born to a mother who is narcotic or methadone-dependent and who takes the drug or drugs in varying dosages for varying periods during her pregnancy.

a. Etiology.

Drugs that the mother has taken during pregnancy crosses the placental barrier and enter the fetal circulation. Supply to the infant is abruptly terminated at delivery. Other agents (for example, phenobarbital and Darvon®) are capable of causing withdrawal symptoms).

b. Degree of Withdrawal Symptoms.

The degree of withdrawal symptoms the infant manifests may be related to the duration of the mother’s habit, the type and dosage requirements of her addiction, and her drug level immediately prior to delivery.

c. Onset of Symptoms.

Heroin and methadone are the narcotic drugs most commonly involved in neonatal drug addition.

(1) Heroin addition is seen several hours after birth to three to four days of life.

(2) Methadone addition is seen seven to ten days after birth to several weeks of life.

d. Signs of Withdrawal.

(a) Coarse, flapping tremors.

(b) Prolonged, persistent, high-pitched cry.

(c) Vigorous, ineffective sucking, poor feeding.

(d) Excessive tearing and sweating.

(e) Sneezing, nasal stuffiness.

(f) Convulsions – with methadone withdrawal.

(g) Hyperpyrexia (an excessively high body temperature).

e. Size.

High incidence of infants born to addicted mothers are premature and/or small for gestational age.

f. Treatment.

(1) Narcotic antagonist is used to counteract narcotic-induced respiratory depression.

(2) Drug therapy is used for alleviation of signs of narcotic withdrawal.

(3) Supportive therapy is given as appropriate.

g. Nursing Care Considerations.

(1) Be familiar with withdrawal symptoms to facilitate early diagnosis in order to decrease morbidity/mortality of high-risk infants.

(2) Record accurately and in detail all signs and observations of withdrawal.

(a) Time of onset.

(b) Duration and frequency.

(c) Severity.

(d) Treatment initiated and response.

(e) Vital signs.

(3) Decrease environmental stimuli, minimize handling.

(4) Be flexible in delivery of nursing care. The infant may be responsive to swaddling one time and react with irritability the next.

(5) Maintain fluid/caloric requirements.

(a) I&O.

(b) IV

(c) Increased caloric intake.

(d) Feed on demand schedule.

(6) Know drug actions/adverse reactions when the infant is receiving drug therapy.