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Qualitative paper on eonatal abstinence syndrome after in utero exposoure to selective serotonin reuptake inhibitors in term inf - Essay Example

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SUMMARY NAS is a complex of varied behavioral and physiologic signs and symptoms resulting from prenatal and maternal substance use that cause withdrawal symptoms. This is an important public health issue, since (3% of 4.1 million) women of child-bearing age still use drugs during pregnancy…
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Qualitative paper on eonatal abstinence syndrome after in utero exposoure to selective serotonin reuptake inhibitors in term inf
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Download file to see previous pages Its prevalence and long-term adverse effects all make the studies on this syndrome an important endeavor. INTRODUCTION Symptoms Manifestation of symptoms may occur between 24 hours to two weeks, depending on the half-life of the substance used. Low birth weight, prematurity, and intrauterine growth retardation are common. Those exposed to cocaine show hyperactive Moro reflex, jittering, and excessive sucking. Exposure to caffeine and subsequent accumulation of blood methylxanthine impairs neonatal habituation, orientation, autonomic regulation, exaggerated startle reflex and tremor, as well as auditory orientation. Marijuana exposure leads to hypoglycemia, hypocalcemia, sepsis, hypoxic encephalopathy, intracranial hemorrhage, tachycardia, poor perfusion, irritability, and poor feeding. SSRIs during the last trimester may manifest as irritability, agitation, tremors, tachypnea, nasal congestion, emesis, or diarrhea. These symptoms disappear by two weeks. Other symptoms that may support the diagnosis of NAS are microcephaly, congenital infection, congenital malformations, high-pitched cry, sleep duration less than 1-3 hours after feeding, tremors, hypertonia, myoclonic jerks, generalized convulsions, sweating, fever, mottling, frequent yawning, sneezing, nasal flaring, respiratory rate of greater than 60 breaths per minute, apnea, poor feeding, hyperphagia, regurgitation, and loose stools (Hamdan, 2012). Diagnosis The Finnegan Scoring System is developed based on opiate withdrawal, and thus may not be appropriate for infants exposed to other drugs. It is the most widely used scoring system, attributable to its relative ease of use and reliability once conducted by a trained stuff. Despite this, it is still prone for bias and subjectivity. Aside from diagnosis, it can assess the effectiveness of treatment. If NAS is suspected, radioimmunoassays, enzyme immunoassays, blood tests, urine toxicology assays, meconium analysis or hair analysis may be conducted to confirm substance use by the pregnant mother (Hamdan, 2012). Causes The syndrome can be caused by abrupt discontinuation of opioid, more commonly fentanyl, especially after prolonged drug use. Aside from opioids, barbiturates, caffeine, cocaine, selective serotonin reuptake inhibitors (SSRIs), antihistamines, ethanol, marijuana, nicotine, phencyclidine, meprobamate, glutethimide, ethchlorvynol, and benzodiazepines are noted to cause NAS. Tolerance and physical dependence are seen more rapidly among users of shorter acting drugs and continuous infusion, usually after 5 or more days of continuous infusion of fentanyl. Maternal substance abuse is the leading preventable cause of mental, physical, and psychological problems in infant and children. Certain drugs, such as cocaine and amphetamines, stimulate the release and block the reuptake of dopamine, epinephrine, norepinephrine, and serotonin. Such activity is similar to the activity of SSRIs (Hamdan). Serotoninergic hyperstimulation causes stimulation such as jitterness, tachypnea, hypertonicity, temperature instability, and diarrhea. These symptoms should manifest shortly after birth, since drug exposure, which is a vital factor for symptom presentation, does not continue after birth (Levinson-Castiel et al., 2006). Pathophysiology The drugs noted above cause tolerance and addiction to the infant because of their ability to pass through the placental barrier. For example, psychiatric drugs are usually ...Download file to see next pagesRead More
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