Master the board step 3
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Master the board step 3

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Pediatrics<br />

Substance Abuse and Neonatal Withdrawal<br />

Neonatal withdrawal presents with <strong>the</strong> following:<br />

··<br />

Hyperactivity<br />

··<br />

Irritability<br />

··<br />

Fever<br />

··<br />

Diarrhea<br />

··<br />

Tremors/jitters<br />

The timing of withdrawal:<br />

··<br />

High-pitched crying<br />

··<br />

Sneezing<br />

··<br />

Restlessness<br />

··<br />

Vomiting<br />

··<br />

Nasal stuffiness<br />

··<br />

Poor feeding<br />

··<br />

Seizures<br />

··<br />

Tachypnea<br />

··<br />

Heroin, cocaine, amphetamine, and alcohol withdrawal: Presents within<br />

<strong>the</strong> first 48 hours of life.<br />

··<br />

Methadone withdrawal: Presents within <strong>the</strong> first 96 hours (up to 2 weeks).<br />

This drug is associated with a higher risk of seizures.<br />

Complications<br />

Infants of addicted mo<strong>the</strong>rs are at higher risk for <strong>the</strong> following complications:<br />

··<br />

Low birth weight<br />

··<br />

Intrauterine growth restriction (IUGR)<br />

··<br />

Congenital anomalies (alcohol, cocaine)<br />

··<br />

Sudden infant death syndrome (SIDS)<br />

Also, watch out for complications of <strong>the</strong> mo<strong>the</strong>r’s conditions, such as:<br />

··<br />

Sexually transmitted diseases<br />

··<br />

Toxemia<br />

··<br />

Breech<br />

··<br />

Abruption<br />

··<br />

Intraventricular hemorrhage (cocaine use)<br />

Treatment<br />

The best initial treatment is to prescribe opioids (especially if specific prenatal<br />

opioid use was known) and phenobarbital.<br />

Never give naloxone to an<br />

infant born from mo<strong>the</strong>r<br />

with known narcotics use.<br />

It may precipitate sudden<br />

withdrawal, including<br />

seizures.<br />

371

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