1. Education Guide for Parents and Caregivers

2. Neonatal Abstinence Syndrome (NAS) NAS may present in a baby who is exposed to medication taken by the mother prior to birth

3. Withdrawal NAS is the signs and symptoms of withdrawal after birth. It can be severe if not accurately assessed and treated. Methadone and Subutex withdrawal may not be seen until 3-7 days after birth. The length of stay for the baby may vary from 10 days to several months.

4. Finnegan Scoring System A tool used to assess withdrawal symptoms in the baby. Based on the baby’s scores decisions will be made as to if or when the medication will start. Receiving medication is called replacement therapy. Morphine Methadone

5. Finnegan Scoring System The dose and medication used will depend on Finnegan Scores, weight, and the type of medication used during pregnancy. Medications are adjusted or weaned based on withdrawal signs. Every baby responds differently to the weaning process. Sometimes medication is stopped and may need to be restarted due to withdrawal signs.

6. Finnegan Scoring System (refer to actual tool) Contains 21 symptoms of withdrawal divided into 3 categories: 1.Central Nervous System Disturbances 2. Gastrointestinal Disturbances 3. Respiratory and Vasomotor Disturbances

7. Finnegan Scoring System Assessment is not of a single point in time, scores should reflect all the symptoms observed since the last scoring time. Observation by the healthcare worker and parents for symptoms is very important. The baby will be scored every 3 hours before feedings.

8. CNS Disturbances Excessive or high pitched cry Sleeplessness Excoriation skin breakdown on chin, knees, elbows, toes, or nose Jerks or tremors, jitteriness, irritability

9. CNS Supportive Measures Soothe baby with swaddling Talk/hum quietly Hold baby close to body Use infant swing/vibrating chair Reduce noise and lighting in room Skin to skin holding (kangaroo care) Use protective skin creams Handle baby with slow gentle movements Use infant massage or swaddle bath

10. Gastrointestinal Disturbances Excessive sucking- does not always mean they are hungry Poor feeding Vomiting Skin breakdown due to loose stool/diarrhea Gas pain

11. Gastrointestinal Supportive Measures Use pacifier/sweet ease Feed on 3 hour schedule (reduce noise during feeding) Use breast milk (may reduce the severity of the symptoms) Burp regularly Do not overfeed Change diaper often

12. Respiratory/Vasomotor Disturbances Sweating Fever (temp >99) Nasal stuffiness/excessive nasal secretions Nasal flaring/fast breathing (> 60 bum) Yawning Sneezing Mottled color

13. Respiratory/Vasomotor Supportive Measures Do not overdress or over swaddle baby Use infant sleep sac Use gentle suction if nasal secretions cause blockage Respiratory/Vasomotor Supportive Measures

14. Safe Sleep Back to Sleep Best position is on back, in sleep sac, in crib Infant swings/vibrating chairs may be utilized at intervals while parent is awake. Infant should never be left unattended on couch or chair. Infant should never sleep on couch or in chair with parent.

15. Thank You! Parent presence is very important for early response to withdrawal signs and calming the baby. We realize this is very tiring. We suggest parents take turns with care/feeding activities to allow themselves to rest. Also, break periods outside may help you refresh. Do not hesitate to ask for help from the staff. We are a team working together for the common goal of getting your baby home as quickly and safely as possible!