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Neonatal Abstinence Syndrome
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Abstract
Neonatal abstinence system refers to a series of problems in the newborns as a result of the abrupt termination of the substances abused by the pregnant mothers. NAS is becoming a common condition in nations across the globe and much consideration about this condition is made in the clinical field in the world. There have been great contributions towards knowledge, treatment, and results about NAS in the medical field although insights into this area show significant challenges to the clinicians. The condition is evident by more than fifty percentage of all the children exposed to drug substances during the pregnancy period. The indicators of withdrawal in NAS affected newborns remain nonspecific; however, various scoring systems are employed by the clinicians in the detection of the severity of withdrawing thus providing room for appropriate medical therapy. Its management largely depends on the diagnosis of urine and the Finnegan scoring systems. The scoring systems aids in the assessment of the severity, initiating, monitoring and termination of the medications. Several drugs are safe and efficient in containing this condition among the newborns. Medical practitioners use the nonpharmacological care as the initial treatment method which is followed by pharmacological care upon the development of severe withdrawals. The treatment of NAS often relies on the use of morphine. This paper, therefore, highlights the NAS condition with its impacts on the affected entities, various treatment methods and long-term effects on the baby.

Moreover, it explores different Opioid substances and side effects on the baby.

Introduction
As a clinical diagnosis, Neonatal abstinence syndrome is a consequence that results in abrupt termination of the substances abused by the pregnant mothers. The discontinuation of substances on the newborn baby causes functionality problems preceding a series of challenges to the health of the child. It specifically affects the autonomic nervous system and gastrointestinal tract making this condition a multisystem disorder. The withdrawal from prolonged maternal opioid is sometimes severe to the child, and its effects are intense to the child. Medics indicate that NAS is rarely fatal, but its effects are significant considerations due to the illnesses caused coupled by prolonged hospital stays.
The many symptoms experienced by newborn babies linked to NAS results from the opioid eight dependency and sedative-hypnotic drugs. Scientifically, most NAS affects only kids whose mothers are opioid dependent. Methadone and several opiate withdrawals significantly contribute to severe cases of this condition among the infants reported. The substances contained in opioids triggers the activation of u-opioid receptors in the nervous system and gastrointestinal tract. Opioids refer to the synthetic opioids such as the medications like methadone whereas the opiates are the non-synthetic. These substances cross through the placenta to the fetus causing the same reactions and body responses. The u-opioids receptors activate the central dopamine pathways resulting in the same body responses and effects to the child just like the mother (Avidan, 2015).
High frequencies of dopamine activation lead to dependency on opioids to the fetus. All opioids exposures result in these effects and symptoms. The pregnant should adopt the use of controlled doses of methadone as opposed to uncontrolled doses obtained outside health care centers. Methadone maintenance treatment on both the child and the mother is encouraged to prevent the onset of possible withdrawals as it reduces the severity of the symptoms of withdrawals. In instances where the mother tries to quit drug abuse while pregnant, the child is consequently affected by the pullout. Some situations are severe and fatal for the fetus as the stress undergone by the mother translates to the child. The methadone medication is therefore continued even for pregnant women with the aim of control over the drugs intake and fetus survival.
NAS presents a series of signs and symptoms in the affected child thus making this condition a critical clinical entity. At presentation, the child shows signs of tremors, irritability, and diarrhea. Also, the child may cry excessively and experience seizures. The signs in multiple systems often appear in phases with symptoms attributed central nervous system being first to appear. As the child ages, the hyperirritability causes agitation, difficulties in sleeping and inconsolable crying. Further, the clinical presentations indicate that the crying among the neonates is usually high pitched and uncontrollable with a calling for immediate attention.
Methadone withdrawals led to tremors and hypertonia and exaggerated Moro reflex. The clinicians ought to differentiate this condition as it appears more close to seizures. Statistics indicate that seizures occur at a rate of 2% to 10% among the children with NAS. They also note that this condition is a serious consequence that needs immediate treatment.
The autonomic nervous system is also affected due to dysregulation and instability. The neonates reporting NAS conditions experiences physiological responses such as the high heart rate, muscle tone and irregularities in the respiratory rate. The signs associated with the autonomic nervous system include sweating, sneezing, and instabilities in temperatures. Such conditions have been reported to persist for longer periods such months (Kocherlakota, 2014).
The baby health is affected in various ways as a result of this condition. Initial effects reported on neonates include poor weight gain, dehydration, and electorate imbalance. Neonates indicate poor weight gain due to poor feeding and excessive motor activity. The dehydration is as a result of diarrhea and vomiting in infants. Mostly, heroin withdrawals have severe diarrhea and electrolyte imbalance. Secondary effects among the children include the perianal skin excoriation and hyperphagia. Irritability and agitation that results from the excessive loose stools affect the child’s skin significantly causing the perianal skin excoriation. The skin condition may appear on other body parts such as face and body due to irritability and agitation.
All these effects on the child regarding onset, duration, and severity depend on the specific types of drugs abused while pregnant. The characteristics and pharmacological properties of these drugs produce various effects on the infants. Such variations arise since different substances have different half-lives, receptor binding capacities, and affinities. Moreover, the transferability of these drugs through the placenta to the child relies on the type of drugs and amounts taken by the mother (Van Marter, 2012).
Methadone or Buprenorphine have known examples of opioid abuse that leads to the neonatal abstinence condition. The onset, duration of the effects and frequency are different depending on the opioids exposed to one. Methadone or Buprenorphine opioids effects appear later, and its withdrawal effects take extended periods of time. Contrary, heroin and methamphetamines exposure results in immediate signs whose withdrawal effects are for a short time. Psychotropic medications mostly induce the withdrawals that are self-limiting and transitional. High doses of these drugs such as the benzodiazepines result in delayed onsets. Therefore, neonates born at term and with good birth weight are susceptible to severe and prolonged withdrawal. Also, those with delayed drug metabolism will have the same conditions of susceptibility and severity.
The treatment measures for this disease are highly recommended just like any other medical condition. The initial treatment commences by administration of non-pharmacologic measures for the infants. The health care practitioners practice gentle handling and noise control measures. They also perform swaddling and demand feeding on the baby. The pharmacological therapy largely depends on the test results of abstinence score. Therefore, medical treatments are performed when the Finnegan score is eight or more as it indicates that the condition is severe. Medical practitioners consider the individual’s condition in determining the type of treatment. The conditions also include the levels of pain and its need for management or sedation. The medical therapy aims at creating smooth withdrawal by the infant with minimum or o excitements that may result in symptoms. The administration reduces the amount of dosage gradually over a period. This approach is best recommended as the infant can tolerate mild withdrawal symptoms, able to feed well and sleep. This process usually takes different time periods among different children depending on the tolerance levels and discharge dose in a particular baby (Logan, Brown, & Hayes, 2016).
Pharmacologic Therapies for NAS are of various types. The most common one is the use of oral morphine sulfate. This drug is adopted in cases that show simple opioid withdrawal, and the infants show no other clinical conditions. Other medications used actually in control of NAS include sublingual buprenorphine and paregoric. The medication is applied in low and high dose regimens depending on the individuals. “The high-dose regimen consists of 0.08 to 0.1 mg/kg every 4 hours, and the lower-dose regimen calls for a dose of 0.03 to 0.04 mg/kg every 4 hours.” Further, this dosage is usually varied at intervals with an increase of 20% of the standard dosage to control the symptoms. Often, the medication is applied through maintenance of the same dose for three consecutive days which is then decreased by 20% percent in following days. It is the most used adopted approach although the application is usually individualized (Logan, Brown, & Hayes, 2016).
Some medications contain hazardous ingredients and currently, have been dropped. Such drugs include the paregoric specifically in treating the ameliorating withdrawal symptoms, and they contain alcohol and benzoic acids. All these medications adopt the weaning mechanisms that reduce the dosage by 20% every day.
Statistics indicates a growing number of the opioid abuse among the United States citizens consequently increasing the cases of NAS. A report published in the year 2014 by “The Substance Abuse Mental Health Services Administration” indicates that the 1.1 % of expectant mothers abused opioids mostly pain relievers and heroin. It also shows an increase in the maternal opioid use. The NAS conditions are uniformly reported in all community hospitals across the country. Heroin abuse has substantially increased in developing countries compared to developed countries. The unmarried mothers who are either unemployed or with fewer education levels mostly abuse these drugs. Severe cases of NAS are commonly facilitated by unplanned pregnancies and minimal prenatal care. In turn, the infants develop NAS condition upon birth with adverse health effects, low birth weights, and restrictions on the growth.
The social implications of this disease are harmful to the immediate parties that are affected. Although the parent to the infants with NAS condition feels guilty and ashamed as they are seen as the cause of the problems, psychological counseling is useful in both early and late stages of infants growth. The knowledge acquired in this field is more useful factoring in the experiences I had with a friend who had the same problem (Ramakrishnan, 2014). It highlights the medications, causes and handling procedures helpful in managing this condition. Moreover, the stipulated guidelines in medical and non-medical treatment approaches are of great impact when dealing with close friends and relatives in our surroundings.
NAS affects the not only the life of the infant but also the immediate family member and close friends. It is a social and economic problem that ought to be eliminated. Although this condition is curable, it is more desirable if the concerned bodies take first measurements to prevent it from occurring. Such measures include the abstinence from opioid abuse and taking proper antenatal care. The medical practitioners use both pharmacological and non-pharmacological treatment options to contain this condition. The relevant authorities and all stakeholders should also take measurable action that reduces chances of substances abuse mostly in developing countries where such cases have been highly reported to be on the rise.

References
Avidan, O. (2015). The growing crisis in Maine: Neonatal abstinence syndrome.
Kocherlakota, P. (2014). Neonatal Abstinence Syndrome. AAp News and Journals Gateway. Retrieved 30 November 2016, from http://pediatrics.aappublications.org/content/134/2/e547Logan, B., Brown, M., & Hayes, M. (2013). Neonatal Abstinence Syndrome: Treatment and Pediatric Outcomes. NCBI Resources. Retrieved 30 November 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589586/
Ramakrishnan, M. (2014). Neonatal Abstinence Syndrome: How States Can Help Advance the Knowledge Base for Primary Prevention and Best Practices of Care. Astho.org. Retrieved 30 November 2016, from http://www.astho.org/Prevention/Rx/NAS/
Van Marter, L. (2012). Neonatal Abstinence Syndrome and Associated Health Care Expenditures: United States, 2000-2009. Yearbook Of Neonatal And Perinatal Medicine, 2012, 268-270. http://dx.doi.org/10.1016/j.ynpm.2012.06.068