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What is the accepted name of the condition with which the child will be born?

This infant will be born with a condition called Neonatal abstinence syndrome (NAS). This is a condition that affects newborns who receive opioids or addictive substances through the placenta during pregnancy (Cleveland Clinic, 2024). Neonatal opioid withdrawal syndrome (NOWS) is a subset of NAS and is specified to opioid withdrawal during the first 28 days of life (CDC, 2024)

What is the peri-natal risks to the infant?

NAS is influenced by many factors, including maternal-fetal-placental pharmacokinetics, neurotransmitter dysregulation, and genetic and epigenetic factors. The pathophysiology underlying NAS is not entirely understood. The extent of neonatal exposure likely plays the largest role. There appears to be a direct relationship between the gestational age and the amount of opioids transferred across the placenta. (Anbalagan et al., 2024).

What are the postnatal risks to the infant?

NAS is a constellation of signs and symptoms with multisystem involvement. The clinical features are categorized into CNS, autonomic, respiratory, and GI system disturbances (Anbalagan et al., 2024).

CNS symptoms typically include hyperirritability, high-pitched crying, jitteriness, and tremors. Hyperirritability leads to sleep disturbances and difficulty maintaining a calm state. Myoclonic jerks and seizures are also possible. Autonomic instability leads to changes in vital signs such as tachycardia, tachypnea, and hyper- or hypothermia. Skin perfusion becomes altered, leading to mottling and sweating. Frequent yawning, nasal stuffiness, excessive sneezing, and nasal flaring may also be present. GI symptoms observed in NAS include poor feeding, regurgitation, vomiting, and diarrhea. Heroin withdrawal is more notable for severe GI symptoms and may lead to dehydration and electrolyte disturbances in neonates with an already delicate metabolic balance. Diarrhea may also lead to skin breakdown around the perianal/buttock region and rash. Withdrawal is a state of excessive caloric demand. Combined with GI losses and excessive autonomic stimulation, this can lead to weight loss and failure to thrive. Therefore, increasing caloric intake with feeding in neonates with clinical signs of withdrawal may be necessary (Anbalagan et al., 2024). Severe symptoms the infant can experience include being born prematurely, growth and birth defects, seizures, and SIDS (Cleveland Clinic, 2024).

What are the postnatal risks to the mother?

Postnatal risks to the opioid addicted mother include a high risk of relapse due to stress, increased risk of overdose, and an increased risk of maternal death and other complications such as preeclampsia and placental abruption (Hirai et al., 2021).

Evidence about the long-term effects to the child?

Common long-term effects of NAS can include developmental delays, behavior issues in school and throughout life, short-term memory loss, growth problems, difficulty gaining weight, hearing and vision problems. Additional studies are showing that children born with NAS are at a greater risk for ADHD, anxiety, and depression (Cleveland Clinic, 2024).

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