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Opioid Addiction’s Smallest Victims

Lori A. Brittingham, MSN, RN, CNS, ACCNS-N

President, The National Association of Neonatal Nurses (NANN)

Much has been published regarding America’s opioid abuse crisis, however the public is predominately unaware of the effects of opioid abuse on newborns born to addicted mothers. Neonatal Abstinence Syndrome, or NAS, is a condition that results from the abrupt discontinuation of infant exposure to substances that were used by the mother during pregnancy. Neonatal Abstinence Syndrome is a multi-system disorder that is characterized by symptoms such as crying and irritability, poor feeding and feeding intolerance, and a variety of additional neurologic issues.

A rising problem

A 2015 report published by the Government Accountability Office cited that cases of NAS have tripled over the last decade and that the cost of caring for infants with NAS is more than five times that of caring for healthy newborns. Most infants who suffer from NAS require prolonged hospital stays, sometimes up to three to six weeks. Care is generally provided in neonatal intensive care units and, in some cases, inpatient pediatric units. Treatment for NAS has traditionally concentrated on the use of pharmacologic and non-pharmacologic interventions. Medications and behavioral and environmental modifications such as holding and consoling infants, providing non-nutritive sucking and small frequent feedings, and provision of a calming environment have been the focus of care.

Improving treatment for infants

As cases of NAS have increased over the last several years, there has been an emphasis on optimizing treatment for affected infants. Research efforts have focused on what medications might be most effective in treating this disease process, how to best wean medications, and how to best support hospital staff as the numbers of hospital admissions continues to grow. Most recently, a family-centered approach to care and alternate treatment settings have been studied.

Increased awareness regarding this emerging public health crisis is warranted. This issue furthermore requires studying the long-term outcomes of affected infants, supporting caregivers, advocacy for increased insurance reimbursement to cover the cost of effective treatment and extended hospital stays for infants with NAS and funding for continued research aimed at optimizing treatment.

Lori A. Brittingham, MSN, RN, CNS, ACCNS-N, President, The National Association of Neonatal Nurses (NANN), [email protected]

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