Neonatal Network最新文献

In this perspective letter, we highlight the importance of revisiting early literature in the neonatal opioid withdrawal syndrome field. We summarize key examples of how early articles still are relevant to current research.

The increasing prevalence of maternal substance use, particularly opioids, has led to a significant rise in neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS). This rise presents unique challenges for NICUs across the United States. This article examines the critical importance of maternal engagement in the care of infants affected by NAS/NOWS and identifies the barriers that mothers with substance use disorder encounter, including stigma, fear of legal consequences, and logistical obstacles. Evidence shows that maternal involvement in nonpharmacologic interventions-such as skin-to-skin contact, breastfeeding, and comforting techniques-can mitigate NAS symptoms, reduce the need for pharmacologic treatments, shorten NICU stays, and improve long-term outcomes for both the mother and the infant. The article highlights the value of adopting trauma-informed, family-centered care approaches to encourage maternal participation, reduce stigma, and create a supportive NICU environment. Additionally, it underscores the importance of educating NICU staff about addiction, recovery, and trauma-sensitive communication to improve care and reduce bias. By fostering maternal involvement and providing comprehensive support, NICU teams can significantly improve health outcomes and strengthen the maternal-infant bond for this vulnerable population.

This article provides a brief overview of the incidence, pathophysiology, diagnosis, and management of neonatal abstinence syndrome. Areas of discussion include genetics, pathophysiology, diagnostic tools, and pharmacologic and nonpharmacologic management of neonatal abstinence syndrome.

Access to and quality of health care is one of the five determinants of health that significantly influences the health and well-being of neonates and their families. This column considers the challenges birth parents and neonates may have in accessing care and whether the care they do access is safe and of high quality. As obstetric mortality rates continue to increase and neonatal mortality rates fail to decline in the United States, there is a critical need to consider how nurses can support families in obtaining the care they require. Advocating for access to health care and providing high-quality care that is free from discrimination is necessary to improving outcomes for families and supporting future engagement in the health care system. NICU nurses hold a pivotal role in fostering inclusive environments, providing high-quality care, and advocating for improved access.

Studies suggest that in utero opioid exposure may be associated with congenital heart disease (CHD). We sought to assess the incidence of CHD in infants with neonatal abstinence syndrome (NAS). A review of a national, administrative database from January 2019 to December 2022 was conducted for neonates with an ICD-10 code for NAS and moderate or severe CHD. The incidence of CHD in NAS (the main outcome variable) was compared to those without NAS using χ² analysis and odds ratios for CHD with significant differences. There were 4,994,919 neonatal admissions during the study period: 26,284 with NAS (2.3% had CHD) and 4,968,715 without NAS (1.1% had CHD) (p < .001). Odds ratios for five CHD types (atrioventricular septal defect, aortic coarctation/hypoplastic arch, double-inlet left ventricle, pulmonary valve stenosis, and pulmonary artery stenosis) were higher in NAS. There is the suggestion of a higher incidence of some forms of moderate and severe CHD in neonates with NAS.

Nonpharmacologic management is the first-line therapy for infants experiencing neonatal opioid withdrawal syndrome (NOWS) and/or neonatal abstinence syndrome (NAS). Currently, the most prescribed first-line pharmacologic agent is an opioid, most often morphine, but methadone and buprenorphine are preferred by some providers. For some infants, an opioid, along with maximized nonpharmacologic strategies, does not provide adequate symptom relief and a second-line agent is needed. Phenobarbital and clonidine are two commonly prescribed second-line agents for the management of NOWS/NAS. This column will describe these two commonly prescribed second-line agents.

As a parent in the NICU, we families have an automatic friendship that simply requires the phrase "NICU Baby" for a club none of us expected to join. Along with premature infants, infants with heart conditions, rare diseases, and more, there is one embattled group: the neonatal abstinence syndrome or neonatal opioid withdrawal syndrome infants. So many assumptions swirl around these infants and automatic accusations at the birthing parent. But what if we had a different way, a different prescription in helping this fragile family thrive? It is possible and it is needed.