NEONATAL ABSTINENCE SYNDROME

DAVID RODRÍGUEZ GARCÍA- PEDIATRICS

Introduction

 The set of disorders that an individual has when he is abruptly

deprived of any toxic or drug, which he had previously consumed
regularly.
 In children of mothers who suffer some addiction are more
frequent:
- Congenital infections
- Malnutrition
- Neglected pregnancies, except in mothers
with detoxification treatment with methadone
(health controls of mother’s pregnancy are correct)
OPIATES
 It is the most serious and relevant neonatal abstinence syndrome.
 It has no teratogenic effects on the fetus but increases the probability of
suffering:
1. Abortions
2. Restricted intrauterine growth
3. Prematurity
 In the first 12-24 hours a very marked
abstinence syndrome is developed.
The clinic can be presented in the first
week in heroin, and even in the second
week in methadone.
OPIATES
 The new-born has low weight and signs of:
 Nervous hyper excitability, characterized by: great irritability;
hypertonia and hyperreflexia; shrieking and continuous screaming;temblor,
may have seizures, and continuous movements on the crib and sharp crying.
 Vegetative picture, characterized by: hyperthermia not very high ( 37.5 -
38ºC) of non-infectious origin; sweating; taquipnea or dyspnea, and nasal
congestion
 Gastrointestinal picture: Yawns; a big appetite; diarrheas; vomiting;
difficulties in the feeding.
 Sleep disorders

 The stress situation during pregnancy accelerates lung

maturation, which is why these children have a lower incidence
of hyaline membrane disease!!
Opiates
Diagnosis
 Clinical history (fetal and maternal) and suspicion, from the pediatrician,
of maternal consumption
 Chromographic study in urine or meconium of the products of the drug

Differences between the abstinence syndrome of heroin and methadone

 It usually produces delayed intrauterine growth, but it is more accused in
heroin-dependent mothers.
 However, the abstinence syndrome is more acute and frequent in children
of mothers who take methadone.
 The symptoms are similar, although seizures are more frequent due to
methadone
Previously it was thought that the increase in dose caused an increase in
the syndrome. Now it is known that this is not like this: the dose does
not matter.
CANNABIS (MARIJUANA)
 It has not been shown to have an undesirable neonatal effect: it does not
cause teratogenic effect in the embryogenesis. Neither deprivation syndrome
 Only if the mother is very smoker, some isolated studies talk about hyper
excitability.
 It is consumed together with tobacco, and that one has secondary effects.
Cocaine
 Cocaine does not usually produce abstinence symptoms, although there are
complications in pregnancy (prematurity and placental abruption) and
pathological neonate.
 Cocaine reaches fetus via placenta and causes: Vasoconstriction, tissue
ischemia, which facilitates cellular ischemia, and has fetal teratogenic
effects: malformations for intestinal, cardiac and renal ischemia:
 If the abstinence syndrome occurs, it is very rare and much milder.
 In the long term, it is related to behavioural disorders (problems in
learning and language) and greater neurological excitability
 In addition, it has been linked to sudden infant death syndrome as a risk
factor.
ALCOHOL
 It can cause an abstinence syndrome, but it is less frequent than in
previous drugs. The abstinence picture is very characteristic:
- At birth, the child's breathe smells like alcohol. First, the child enters a
phase of hyper excitability and hypertonia.
- After two days, he has no longer alcohol in his blood and enters a phase
of lethargy and severe hypotonia.
- Finally enters a state of hypoglycaemia / acidosis.
Tobacco
 Tobacco has important teratogenic effects: It has important vascular
effects on the fetus and on the placenta, in addition to:
- Impairment of lung growth, increases the risk of problems obstructive
(asthma) and makes it more difficult to treat.
- Produce behaviour disorders
- Intrauterine growth restriction, even influence the size of the individual
 His abstinence syndrome in the new-born is little studied, it is known that
there is more hyper excitability at the first moment of birth, but not
comparable to the hyper excitability that is produced by opiates.
 Treatment of neonatal abstinence
syndrome
 The most important thing is: "Give them love and warmth, make them
feel protected":
- As much as possible send it home without treatment
- A social assessment of the child's environment by social workers.
 The pediatrician uses the Finnegan scale, which scores a series of items
to assess the child's condition. The treatment is done in 3 phases:
 Tucking the new-born: Tuck the child and hug him to feel covered
improves the picture. Keep the new-born in a calm environment, without
noises, if possible isolated and immobilized. It is useful:
-The administration of abundant liquid
-Food in smaller and more frequent doses
Treatment of neonatal abstinence
syndrome
 Use of Morphine: When the clinical picture is striking, morphine is given,
which decreases the effect neurological and vegetative.
 Use of diazepam: Diazepam is used as the third choice.
 VERY IMPORTANT: The treatment of the child with abstinence
syndrome requires an exhaustive and continuous monitoring by the
pediatrician