1. Patty Zetterberg, MSN, C-PNP Director, Clinical Operations Medical Practice Management East Tennessee Children’s Hospital Neonatal Abstinence Syndrome and Long-Term Effects of Intrauterine Drug Exposure

2. Tolerance – Dependence – Addiction Tolerance Our body develops tolerance to a drug’s effect so that an increased amount of drug is required to produce effect. Dependence If the supply of the drug is removed then the person will exhibit “withdrawal symptoms”. Addiction The continuing, compulsive nature of the drug use despite physical and/or psychological harm to the user and society.

3. What Problems Does NAS Cause? AT BIRTH Increased risk of preterm birth Low birth weight CNS (Central Nervous System): irritability Musculoskeletal: agitation, tremors, increased tone (stiffening) Respiratory: nasal congestion, increased respiratory rate GI (Gastrointestinal): emesis (vomiting), reflux, diarrhea

4. Typical Course of Treatment Medication 60 % of NAS babies Morphine only LOS 20 days 35% of NAS babies Require adjunctive meds Phenobarbital (15%) Clonidine (9%) Phenobarbital + Clonidine (11%) LOS 28 days Longest LOS = 155 days 5% of NAS babies LOS 31 days

5. Medication Positioning, comfort measures Formula changes for reflux Rooming-In Home…follow-up appointments Typical Course of Treatment

6. LONG-TERM EFFECTS Sleep Regulation Mood/Behavior Regulation Attention Regulation Sensory Regulation Pain Management Regulation

7. Sleep Brain opiate receptors and onset/regulation of sleep “Quiet sleep” significantly reduced, even 4-5 weeks after NAS treatment finished Toddler sleep

8. Behavior Regulation Emotional reactivity Lack of self-regulation Rule-breaking Aggression Increase in oppositional defiant disorder

9. Attention Regulation Decreased “executive functioning” Attention: decreased sustained attention, decreased selective attention Impulse control Aggression Decreased perceptual reasoning (envision solutions to non- verbal problems) Decreased information processing Decreased decision-making

10. Sensory Processing Regulation 5 Senses Processing Issue Touch Me/Touch Me Not

11. Pain Management Regulation ???

12. Psychosocial Implications Biological Family Increased risk of neglect/abuse in addicted households 20% increase in maltreatment in cocaine-exposed infants with biological parents 60-90% of drug addicts may have mental, emotional or personality disorders, leading to poor parenting skills

13. Long Term Effects NicotineAlcoholMarijuanaOpiatesCocaineMetham- phetamine GrowthNo consensus on effect Strong effect No effect No consensus on effect Unknown BehaviorEffectStrong effect Effect Unknown CognitionEffectStrong Effect EffectNo consensus on effect EffectUnknown LanguageEffect No effectUnknownEffectUnknown AchievementEffectStrong Effect EffectUnknownNo consensus on effect Unknown Summary of Effects of Intrauterine Drug Exposure (Behnke, 2013)

14. Questions? pszetterberg@etch.com