INFANT OF SUBSTANCE ABUSING MOTHER

INTRODUCTION:
Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same route taken by
oxygen and nutrients, which are needed for the fetus's growth and development. Drugs can affect the fetus in
several ways:
1. Act directly on the fetus, causing damage, abnormal development (leading to birth defects), or death.
2. Alter the function of the placenta, usually by reducing the supply of oxygen and nutrients to the fetus thus
resulting in an underweight and underdeveloped baby.
3. Cause the muscles of the uterus to contract forcefully, thus injuring the fetus by reducing its blood supply or
triggering preterm labor and delivery.
DEFINITION:An infant of a substance abusing mother (ISAM) is one whose mother has taken drugs that may
potentially cause neonatal withdrawal symptoms.Also known as intrauterine drug exposure and maternal drug
abuse.
CAUSES OF SUBSTANCE ABUSE:
 Recreation
 Addiction
 Psychiatric problems

SOME DRUGS THAT CAN CAUSE PROBLEMS DURING PREGNANCY:

 Antianxiety Drug – Diazepam
 Antibiotics – Chloramphenical, Ciprofloxacin, Kanamycin, Nitrofurantoin, Streptomycin, Sulfonamides,
Tetracycline
 Anticoagulants – Heparin, Warfarin
 Anticonvulsants – Carbamazepine, Phenobarbital, Phenytoin, Trimethadione, Valproate
 Antihypertensives – Angiotensin, Thaiazide diuretic
 Chemotherapy Drug – Busulfan, Chlorambucil, Cyclophosphamide, Mercaptopurine, Methotrexate
 Mood-stability Drug – Lithium
 Nonsteriodal- Anti-inflammatory Drugs – Aspirin, Other salicylates
 Oral hypoglycemics – Chlorpropamide, Synthetic progestins, Diethylstilbestrol
 Thyroid Drugs – Methimazole, Propylthiouracil, Radioative iodine
 Vaccines – Live virus vaccine, i.e. MMR, OPV, chicken pox, yellow fever

SOCIAL DRUGS:
 Cigarette Smoking: The most consistent effect of smoking on the fetus during pregnancy is a reduction in
birth weight. Birth defects of the heart, brain, and face are more common among babies of smokers than
among those of nonsmokers, including sudden infant death syndrome (SIDS), miscarriages, deficiencies in
physical growth and in intellectual and behavioral development. These effects are thought to be caused by
carbon monoxide and nicotine.
 Alcohol: Leading known cause of birth defects. The risk of miscarriage, low birth weight about 4 pounds.
Fetal alcohol syndrome is one of the most serious consequences of drinking during pregnancy. This
syndrome includes inadequate growth before or after birth, facial defects, a small head, mental retardation,
and abnormal behavioral development. Abnormal and heart defects are present. Babies of women who drank
alcohol during pregnancy may have severe behavioral problems, such as antisocial behavior and attention
deficit disorder.
 Caffeine: It is a stimulant that readily crosses the placenta to the fetus. Thus, it may stimulate the fetus,
increasing the heart and breathing rates. Caffeine also may decrease blood flow across the placenta and
decreases the absorption of iron (possibly increasing the risk of anemia). Drinking 7-8 cups or more/day
increases the risk of having a stillbirth, premature birth, low-birth-weight baby, or miscarriage.
 Aspartame: Aspartame, an artificial sweetener, appears to be safe during pregnancy when it is consumed in
small amounts, such as in amounts used in artificially sweetened foods and beverages.
1
 ILLICIT DRUGS:
 Use of illicit drugs (particularly cocaine and opioids) during pregnancy can cause complications during
pregnancy and serious problems in the developing fetus and the newborn. Injecting drug using is increasing
the risk of infections that can affect or be transmitted to the fetus, hepatitis and STD (including AIDS). Fetus
growth is more likely to be inadequate, and premature births are more common.
 Cocaine: Cocaine readily crosses the placenta and affects the fetus. It constricts blood vessels, reducing
blood flow (and the oxygen supply) to the fetus, particularly of the bones and the intestine. Rarely, use of
cocaine results in birth defects of the brain, eyes, kidneys, and genital organs. Use of cocaine during
pregnancy can also cause complications during pregnancy, about 31% have a preterm delivery and 15% have
premature detachment of the placenta (placental abruption). Newborns may have withdrawal symptoms.
Their behavior is also affected. Newborns interact less with other people. Babies of cocaine users may be
hyperactive, tremble uncontrollably, and have difficulty learning (which may continue through age 5 years or
even longer).
 Opioids: Such as heroin, methadone, and morphine, readily cross the placenta. Consequently, the fetus may
become addicted to them and may have withdrawal symptoms 6 hours to 8 days after birth. However, use of
opioids rarely results in birth defects and increases the risk of complications, such as miscarriage, abnormal
presentation of the baby, and preterm delivery. Babies of heroin users are more likely to be small.
 Amphetamines: Use of amphetamines during pregnancy may result in birth defects, especially of the heart.
 Marijuana:The main ingredient of marijuana, tetrahydrocannabinol, can cross the placenta and thus may
affect the fetus. If marijuana is used heavily during pregnancy, newborns may have behavioral problems.

DRUGS USED DURING LABOR AND DELIVERY:

 Local anesthetics, opioids, and other analgesics usually cross the placenta and can affect the newborn. For
example, they can weaken the newborn's urge to breathe. Therefore, if these drugs are needed during labor,
they are given in the smallest effective doses

CLINICAL MANIFESTATIONS:
Babies born to substance abusing mothers may have short or long term effects.
 Short term withdrawal symptoms may consist only of mild fussiness.

2
 More severe findings may include acting irritable or jittery, feeding problems and diarrhea. Symptoms vary
depending on which substances were used.
 More significant long- term developmental problems may be seen in babies who are born with growth
failure or various organ problems.
 Infants born to mothers, who drink alcohol, even in modest amounts, are at risk for fetal alcohol syndrome
(FAS). This condition consists of growth problems, unusual facial features, and intellectual disability. It
may not be detected at time of birth.
 Other drugs may cause birth defects involving the heart, brain, bowel, or kidneys.
 Babies who have been exposed to drugs, alcohol, or tobacco are at the risk for SIDS (Sudden infant death
syndrome).
SCREENING AND INTERVENTION:
A history of drug and alcohol use should be obtained at initial contact with every pregnant patient and when
taking a newborn history. With a positive history, intervention should begin immediately with counseling on
risk reduction and referrals for social services and for treatment programs. Drug screening of the mother
cannot be done without her consent and screening of the infant should never occur without the mother being
informed of the testing and reasons for the testing. Screening should always ensure the right of privacy of the
mother and still allow physicians to optimize medical care to both mother and infant. The primary focus should
be to ensure that interventions are designed to foster the health of both patients.
Every infant born to a substance abuser should be evaluated for HIV infection.
URINE TOXICOLOGY SCREENING is recommended for the following infants:
 Maternal history of drug abuse (past or current)
 Maternal evidence of drug use (track marks, altered mental status) -History of a partner using drugs
 History of previous children removed from the home
 Maternal homelessness, prostitution or history of psychiatric illness
 No prenatal care, inadequate prenatal care, late onset of prenatal care
 Neonatal signs consistent with drug effects
TREATMENT:
The baby’s treatment will depend on the drugs the mother used. Treatment may involve:
 Limiting noise and bright lights
 Maximizing TLC (tender loving care)
 Using medications (for some)
In the case of babies whose mother used narcotics, the baby is most given small dose of a narcotic at first. The
amount is slowly adjusted as the baby is weaned off of the substance over days to weeks. Sedatives are
sometimes used as well.
Infants with organ damage, birth defects or developmental issues may need medical or surgical therapy and long
term therapies.
NURSING MANAGEMENT FOR HIGH RISK INFANT:
Nursing diagnosis-
 Ineffective breathing pattern related to pulmonary and neuromuscular immaturity.
 Ineffective thermoregulation related to immature temperature control and decreased subcutaneous fat.
 Risk for infection- risk factors include deficient immunological defenses, exposure to environmental
pathogens, required invasive procedures and invasive equipment
 Imbalance nutrition: less than body requirement- related to inability to ingest nutrients
 Risk for impaired skin integrity- risk factors include immature skin structure, physical immobility,
decreased fluid intake and invasive procedures
 Interrupted family processes- related to preterm birth, situational crisis, interruption of parent-infant
interaction.
Nursing interventions:
1. RESPIRATORY SUPPORT: The primary objective in the care of high risk infant is to establish and
maintain adequate respiration. Many infants require supplemental oxygen and assisted ventilation. All
infants require appropriate positioning to maximize oxygenation and ventilation. Oxygen therapy is
provided on the basis of infant’s requirement and illness.

3
2. THERMOREGULATION:After or concurrent with the establishment of respiration, the most crucial need
of high risk infants is application of external warmth. A neutral thermal environment is one that permits
the infant to maintain a normal core temperature with minimum oxygen consumption and calorie
expenditure. The three primary methods for maintaining a neutral thermal environment are the use of an
incubator, a radiant warmer and open bassinet with cotton blankets. Skin to skin contact between a stable
preterm infant and parent is also a viable option.
3. PROTECTION FROM INFECTION: It is an integral part of all newborn care, but sick neonates are
particularly susceptible. Incubator should be regularly cleaned and changed to provide effective isolation
of air borne infective agents. An annual influenza vaccination is recommended for NICU personnel.
Standard precautions should be maintained. Equipments used in the care of infants are cleaned on regular
basis such as incubators, mattresses, radiant warmers etc.
4. HYDRATION: Parenteral fluids may be given to the high- risk neonate via several routes depending on
the nature of the illness, the duration and type of fluid therapy, and unit preference. The preferred sites for
peripheral IV infusions in neonates are the peripheral veins on the dorsal surface of the hands or feet. IV
fluids must always be delivered by continuous infusion pumps that deliver minute volumes at a present
flow rate. Infants who are tachypneic, receiving phototherapy, or in a radiant warmer have increased
insensible water losses that require appropriate fluid adjustment. Nurse must monitor fluid status by
daily(or more frequent) weights and accurate intake and output of all fluids, including medications and
blood products. Serum electrolytes are monitored per unit protocol, and urine electrolytes are obtained as
warranted by the infant’s condition.
5. NUTRITION: The amount and method of feeding are determined by the infant’s size and condition. It can
be provided by either the parenteral or the enteral route or by a combination of the two. Infants who are
critically ill often obtain the majority of their nutrients by the Parenteral route because of their inability to
digest and absorb enteral nutrition. Total Parenteral nutrition support of acutely ill infants may be
accomplished successfully with commercially available I.V. solutions specifically designed to meet the
infant’s nutritional needs, including protein, amino acids, trace minerals, vitamins,
carbohydrates(dextrose), and fat(lipid emulsion).