Neonatal abstinence syndrome

Domain 9. Coping-stress tolerance
Class 3. Neurobehavioral stress
Diagnostic Code: 00264
Nanda label: Neonatal abstinence syndrome
Diagnostic focus: Neonatal abstinence syndrome

Understanding Neonatal Abstinence Syndrome (NAS)

Neonatal abstinence syndrome (NAS) is a postnatal condition where infants are born dependent on drugs they were exposed to while in the womb as a result of their mother's substance use disorder. NAS is often caused by substances such as opioids, tobaccos, alcohol, and benzodiazepines, which can create withdrawal symptoms in the infant after birth. Babies born with NAS may experience a wide variety of problems including seizures, tremors, vomiting, diarrhea, trouble sleeping, difficulty sucking and feeding, and high-pitched crying.

NANDA Nursing Diagnosis

The North American Nursing Diagnosis Association (NANDA) has identified nursing diagnosis relating to neonatal abstinence syndrome (NAS). These diagnoses are intended to aide healthcare providers in evaluating, diagnosing, and treating infants suffering from NAS. They include:

1. Intrauterine Growth Restriction

This diagnosis is used when a newborn is significantly smaller than expected for the gestational age due to having been exposed to certain substances during intrauterine development or when the baby does not gain weight or grow in expected ways.

2. Risk for Injury

This diagnosis is based on the premise that newborns with neonatal abstinence syndrome are at risk of injury due to withdrawal symptoms and difficulties regulating their body temperature and behavior.

3. Ineffective Infant Feeding Pattern

This diagnosis is based on the belief that infants with NAS are more likely to display feeding difficulties that could affect overall health.

4. Impaired Parenting

This diagnosis is based on the idea that parents dealing with substance use disorders are less likely to provide appropriate care for their newborns affected by NAS.

5. Anxiety

This diagnosis is based on the belief that newborns with neonatal abstinence syndrome may experience anxiety from withdrawal symptoms and difficulty obtaining food, sleep, and comfort.

Defining Characteristics

Subjective Characteristics

Subjective characteristics associated with neonatal abstinence syndrome may include:

• Fussiness, irritability, and inconsolability
• Tremors and/or jitteriness
• Excessive crying or high-pitched crying
• Poor caloric intake and slow weight gain
• Altered breathing patterns
• Hyperactive reflexes
• Yawning, sneezing, and/or bothersome jerking movements
• Difficulty falling and staying asleep
• Sweating or clammy skin
• Vomiting
• Diarrhea
• Frequent stirring and stretching

Objective Characteristics

Objective characteristics associated with neonatal abstinence syndrome may include:

• Premature birth
• Low birth weight
• Slow growth and weight gain
• Seizures
• High-pitched cry
• Irritability
• Decreased rem sleep and increased active sleep
• Poor feeding, sucking, and swallowing
• Excessive sweating
• Vomiting
• Diarrhea
• Trembling or "jerking" movements
• Hyperactive or exaggerated reflexes
• Stiffness and/or tense muscle tone
• Yawning
• Sneezing

Related Factors

Several direct and indirect factors may contribute to neonatal abstinence syndrome (NAS), including:

• The type and amount of substance the mother used during her pregnancy
• Whether the mother used more than one substance while pregnant
• The timing of the mother’s substance use during her pregnancy
• The mother’s history with substance abuse
• The prenatal nutrition and care the mother received
• The presence of genetic, interpersonal, and/or psychosocial disturbances that may affect the mother’s overall health
• Environmental influences

At-Risk Populations

At-risk populations for neonatal abstinence syndrome (NAS) include infants of mothers who have used substances such as opioids, tobacco, alcohol, and benzodiazepines during their pregnancy, as well as infants of mothers who have abused these substances prior to and/or after becoming pregnant.

Suggestions of Use

Healthcare providers can use NANDA nursing diagnosis related to neonatal abstinence syndrome (NAS) to evaluate, diagnose, and provide appropriate treatments for infants affected by the syndrome. Educating mothers of newborns with NAS regarding their children’s condition, medications, healthcare services, nutrition, and potential outcomes can help women better care for and bond with their infants.

Suggested Alternative NANDA Nursing Diagnoses

Alternate NANDA nursing diagnoses related to neonatal abstinence syndrome (NAS) include:

• Ineffective Health Maintenance
• Altered Family Processes related to Substance Abuse
• Chronic Low Self-Esteem
• Social Isolation
• Post-Partum Risk for Bleeding
• Risk for Imbalanced Fluid Volume
• Ineffective Breathing Pattern
• Disturbed Sleep Pattern
• Ineffective Coping

Usage Tips

When utilizing NANDA nursing diagnoses related to neonatal abstinence syndrome (NAS), healthcare providers should remember these important tips:

• Identify which substances the mother used during pregnancy so a proper assessment of the infant can be made
• Evaluate the infant’s physical, mental, and developmental status
• Monitor the infant’s vital signs regularly
• Provide comfort and support to the infant and family
• Encourage breastfeeding as it helps counteract some of the withdrawal symptoms
• Ensure proper nutrition and hydration are maintained
• Administer medications, if necessary, to lessen withdrawal symptoms
• Refer the mother to appropriate counseling services, if needed

NOC Outcomes

NOC outcomes associated with neonatal abstinence syndrome (NAS) include:

• Growth and Development:Measures an infant's cognitive, motor, social, and language development
• Nutritional Status:Measures infant’s weight gain, length/height, and head circumference
• Sleep Quality:Measures the amount of restful sleep an infant receives
• Pain Level:Measures an infant’s level of discomfort or distress
• Temperature Regulation:Measures an infant’s ability to maintain a normal body temperature
• Reflex Response:Measures an infant’s response to visual, auditory, tactile, and/or thermal stimulation

Evaluation Objectives and Criteria

When evaluating infants affected by neonatal abstinence syndrome (NAS), healthcare professionals should look for the following objectives:

• Regulated infant body temperature
• Adequate sleep cycle duration and quality
• Sufficient caloric intake via breastfeeding or formula-feeding
• Improved mood and decreased irritability
• Reduction in withdrawal symptoms such as tremors, hyperactive reflexes, and yawning
• Consistent growth in infant length, head circumference, and weight
• Consistent development milestones in cognitive, motor, social, and language development

NIC Interventions

NIC interventions commonly used in evidence-based practice when dealing with neonatal abstinence syndrome (NAS) include:

• Physical Assessment:This intervention includes assessments of the infant’s physical condition such as size, weight, respiration, tension, and color.
• Infant Comfort Care:This intervention focuses on providing physical and psychological comfort, comfort feedings, massages, and calming activities.
• Parent Education:This intervention provides education to parents on NAS, its treatment, and the importance of bonding and attachment.
• Medication Administration:This intervention involves providing medication to decrease the intensity, duration, and frequency of withdrawal symptoms.
• Nutrition Support:This intervention involves supporting the baby's nutritional needs through breastfeeding, formula-feeding, or parenteral nutrition.

Nursing Activities

Nursing activities specifically related to treating neonatal abstinence syndrome (NAS) include:

• Monitoring infant vital signs
• Observing and recording behavioral changes
• Administering medication as prescribed
• Assessing nutrition and hydration needs
• Carrying out infant comfort care
• Providing emotional support and assistance to parents
• Recommending and/or referring to appropriate community services

Conclusion

Neonatal abstinence syndrome (NAS) is a postnatal condition where infants are born dependent on drugs they were exposed to while in the womb as a result of their mother's substance use disorder. Babies born with NAS may experience a wide variety of problems, and healthcare providers can use NANDA nursing diagnosis related to NAS to evaluate, diagnose, and provide appropriate treatments for affected infants. Educating mothers of newborns with NAS and providing emotional support, comfort care, and nutrition can help families better care for and bond with their infants.

FAQs

Q. What is Neonatal Abstinence Syndrome (NAS)?

A. Neonatal abstinence syndrome (NAS) is a postnatal condition where infants are born dependent on drugs they were exposed to while in the womb as a result of their mother's substance use disorder. Babies born with NAS may experience a wide variety of problems including seizures, tremors, vomiting, diarrhea, trouble sleeping, difficulty sucking and feeding, and high-pitched crying.

Q. How can healthcare providers identify NAS?

A. Healthcare providers can use NANDA nursing diagnosis related to neonatal abstinence syndrome (NAS) to evaluate, diagnose, and provide appropriate treatments for infants affected by the syndrome. Subjective and objective characteristics associated with NAS include fussiness, irritability, tremors, excessive crying, altered breathing patterns, poor feeding, sweating, and diarrhea.

Q. Are there any interventions specifically developed for treating NAS?

A. Yes. NIC interventions commonly used in evidence-based practice when dealing with NAS include physical assessment, infant comfort care, parent education, medication administration, and nutrition support.

Q. How can healthcare providers support mothers of infants with NAS?

A. Healthcare providers can support mothers of infants with NAS by educating them about their child’s condition, medications, healthcare services, nutrition, and potential outcomes. Providing emotional support and assistance to the mother can also help the mother bond with and better care for her infant.

Q. Are there any long-term effects of NAS?

A. Some infants born with NAS may have long-term effects such as delayed speech, impaired cognition, hyperactivity, and learning disabilities. However, further research is needed to confirm the exact long-term effects of NAS.