WhincupA

NEW PERSPECTIVES ON TREATMENT OF NEONATAL ABSTINENCE SYNDROME (NAS)HOSPITAL TREATMENT VERSUS TREATMENT IN FOSTER CARE: 

NEW PERSPECTIVES ON TREATMENT OF NEONATAL ABSTINENCE SYNDROME (NAS) HOSPITAL TREATMENT VERSUS TREATMENT IN FOSTER CARE ALEX WHINCUP NOVEMBER 2006

HYPOTHESIS: 

HYPOTHESIS Babies who receive pharmacological treatment for NAS whilst in the home environment of Foster Care appear to complete the course of treatment much sooner than those babies being treated in hospital.

SPECIALIST FOSTER CARE MODEL: 

SPECIALIST FOSTER CARE MODEL Model of care that allows babies who are to be discharged to foster care post birth but being treated for NAS, can continue treatment in the community with specialist foster carer . Service established in 2001 Currently 4 foster carers in Leeds with specialist training

WHAT IS NAS?: 

WHAT IS NAS? NAS is a generalised disorder characterised by signs and symptoms of central nervous hyperirritability, gastrointestinal dysfunction, respiratory distress and vague autonomic symptoms that include yawning, sneezing, mottling and fever.

WHICH SUBSTANCES CAUSE NAS?: 

WHICH SUBSTANCES CAUSE NAS? Opiates Methadone Codeine Bupernorphine Ethanol Benzodiazepines Barbiturates ?Cocaine ?Amphetamines ?Cannabis

CLINICAL PRESENTATION: 

CLINICAL PRESENTATION High pitched cry GI disturbance failure to feed D&V Uncoordinated suck Restlesness/unconsolable Temperature instability Yawning/sneezing Jitteriness Tremors Onset of symptoms varies with the substance being used by the mother, the quantity, frequency and duration of intra-uterine exposure and the timing of withdrawal (last dose prior to delivery)

DIAGNOSIS & MANAGEMENT OF NAS: 

DIAGNOSIS & MANAGEMENT OF NAS Comprehensive drug history Medical history/complications e.g. sepsis 7 day observation period on Transitional Ward Urine toxicology Withdrawal chart - Finnegan subjective score 4hrly

NAS SCORE CHART: 

NAS SCORE CHART

TREATMENT FOR NAS: 

TREATMENT FOR NAS PHARMACOLOGICAL Follow local guidelines Leeds policy - 2 consecutive scores >8, start treatment 1ST line treatment - morphine sulphate 2nd line treatment - phenobarbitone NURSING SUPPORT Light swaddling Environment Noise reduction Decrease light Feeding regime Use of pacifiers Skin care Scratch mitts Nappy care

TREATMENT FOR NAS.: 

TREATMENT FOR NAS. 25 babies completed treatment in hospital 8 babies continued & completed treatment in foster care (Jan-Dec 2005)

LENGTH OF STAY: 

LENGTH OF STAY Non-dependant baby at LTHT = 2.5 days Baby receiving treatment in hospital =15 days Baby in Foster Care = 9 days 4 days to stabilise in hospital 5 days to complete treatment in F/C (Jan.-Dec.2005)

POSTNATAL DISCHARGE DESTINATION: 

POSTNATAL DISCHARGE DESTINATION

COST PER DAY: 

COST PER DAY

HOSPITAL TREATMENT FOR NAS: 

HOSPITAL TREATMENT FOR NAS ADVANTAGES Non separation Promotes bonding & attachment Closer observation Can be complex case Non segregation DISADVANTAGES Different carers Lack of continuity Unsuitable/difficult environment for both mother & baby Lengthy & expensive care

TREATMENT FOR NAS IN FOSTER CARE: 

TREATMENT FOR NAS IN FOSTER CARE ADVANTAGES Continuity of care Suitable environment Cost effective Biological nurturing Allows for early discharge from hospital DISADVANTAGES Separation of mother & baby Limited contact Unable to assess parenting Effects bonding & attachment ? Effects feeding

TO CONCLUDE: 

TO CONCLUDE Foster care model is a cost effective & efficient use of resources Limitations to hospital system. Need to learn from Foster Care model and develop Home Care For this client group Further research needed, especially long-term outcomes

CONTACT DETAILS: 

CONTACT DETAILS Alex Whincup Drug Liaison Midwife LAU, 19, Springfield Mount, Leeds, LS2 9NG Tel.0113 2951300 Mobile 07985 859833 Alexandrawhincup@leedsth.nhs.uk