The newborn of a drug-addicted mother

Drug addiction of the mother is a risk factor that negatively affects the pregnancy and the development of the newborn. It is accompanied by a whole range of problems: a risky lifestyle, a higher incidence of non-transmissible diseases, a toxic effect on the fetus, the withdrawal syndrome of the newborn after birth, and problematic socioeconomic background.

Pathophysiology
Addictive substances tend to have a low molecular weight and are water-soluble and lipophilic, which is why they easily pass through the placenta into the fetal bloodstream and into the amniotic fluid. The half-life of an addictive substance is usually longer in a fetus than in an adult.

Most addictive substances affect the CNS - they bind to CNS receptors (e.g. opiates) or affect the release and reuptake of various neurotransmitters (e.g. cocaine). This action can have a long-lasting effect on developing dendritic structures.

Addictive substances during pregnancy apparently also affect intrauterine programming through epigenetic or other factors.

Pregnancy
It is often an unmonitored pregnancy, a condition after repeated abortions. History-taking is unreliable. Maternal comorbidities (infectious hepatitis and other sexually transmitted diseases) and malnutrition are common. Many women addicted to drugs use a combination of substances, smoke tobacco, and drink alcohol.

Pregnancy drug addiction is associated with premature birth, premature outflow of amniotic fluid, intra-amniotic infection, and fetal growth restriction. When using cocaine, there is an increased risk of hypertension, placental abruption, heart and cardiovascular complications, and intrauterine fetal death.

Some substances have a teratogenic effect:
 * alcohol: fetal alcohol syndrome;
 * anticonvulsants - barbiturates (phenobarbital): fetal hydantoin syndrome (abnormal pre- and postnatal growth, abnormal CNS function, abnormal craniofacial appearance and abnormal distal limbs); neural tube defects, heart defects, facial clefts, hypospadias, urogenital tract, digestive tract and skeletal defects;
 * cocaine: microcephaly, agenesis of corpus callosum or septum pellucidum, septo-optic dysplasia, lissencephaly, schizencephaly;
 * SSRI (sertraline, citalopram): increases the risk of cardiac septal defects when used in the 1st trimester.

Urine toxicology screening for addictive substances does not reflect exposure to drugs during the entire pregnancy.

Neonatal abstinence syndrome
The onset of clinical symptoms is influenced by the type of addictive substance and its biological half-life, frequency of use, length of addiction, time interval since the application of the last dose, metabolism of the mother and fetus, gestational age of the fetus.
 * Onset of withdrawal symptoms:
 * alcohol, short-acting barbiturates: < 24 hours;
 * heroin: 0-48 hours (peak 12-24 hours after birth);
 * tricyclic antidepressants, SSRI, SNRI: 0-72 hours;
 * cocaine: 48-72 hours;
 * methadone: 1-5 days (peaks 2-3 days after birth);
 * diazepam: 2-6 weeks;
 * long-acting barbiturates: 2-4 months.


 * Opiate withdrawal symptoms:
 * increased irritability (increased tendon and primitive reflexes, hypertonus, hyperacusis, tremors, high-pitched crying);
 * convulsions, sleep disorders, impaired coordination of sucking and swallowing;
 * regurgitation and vomiting, watery stools and diarrhea;
 * tachypnea, apnea;
 * yawning, hiccups, sneezing, stuffy nose;
 * marbling, thermoregulation disorders, sweating, lacrimation, salivation;
 * fever, weight loss.


 * Scoring*the score according to Finnegan (semi-objective assessment) is most often used.


 * Diagnosis
 * RIA, chromatography, spectrometry;
 * urine, sputum of a newborn;
 * urine, blood of the mother.


 * Regime measures
 * limit stimuli (silence, darkness, thermoneutral environment) gentle handling, relaxing positions, tying, cuddling (skin-to-skin),
 * non-nutritive sucking - pacifier, frequent feeding.


 * Pharmacotherapy
 * withdrawal of opiates: morphine' (50-100 µg/kg after 6 hours, possibly increasing by 25-50% every 24-48 hours until symptoms disappear), opium tincture;
 * convulsions during withdrawal syndrome, withdrawal of several types of substances: phenobarbital' (first 20 mg/kg i.v. and then 2.5–5 mg/kg once a day i.v./p.o., it is necessary to monitor the level).


 * Breast feeding
 * some substances pass into breast milk, therefore it is not advisable to breastfeed if the mother continues to use heroin, amphetamine (Pervitin), cocaine or if she is HIV positive.

Effect of individual addictive substances

 * Alcohol
 * Marijuana
 * Pervitin
 * Cocaine
 * Opiates
 * Barbiturates
 * Benzodiazepines
 * USSR
 * Nicotine

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