Health Promotion and Maintenance Q 117
A newborn with narcotic abstinence syndrome is admitted to the nursery. Nursing care of the newborn should include:
A. Teaching the mother to provide tactile stimulation
B. Wrapping the newborn snugly in a blanket
C. Placing the newborn in the infant seat
D. Initiating an early infant-stimulation program
Correct Answer: B. Wrapping the newborn snugly in a blanket
The infant of an addicted mother will undergo withdrawal. Snugly wrapping the infant in a blanket will help prevent the muscle irritability that these babies often experience. Non-pharmacological care, like rooming-in and control of environmental factors, is the first clinical management strategy and should continue even after discharge from the hospital. Breastfeeding should be strongly encouraged unless there is maternal polysubstance abuse or maternal medical contraindication.
Option A: Treatment should always begin with non-pharmacological care while maintaining the mother-infant dyad and should continue even after discharge from the hospital. The goal of non-pharmacological treatment is to assist the self-organization of the neonate and support the neuronal-maturation. AAP has also recommended it as first-line in the management of NAS. These may include changes to the physical environment like darkening the room and quieting the surroundings, to decrease visual and auditory stimuli.
Option C: Placing the infant in an infant seat is incorrect because this will also cause movement that can increase muscle irritability. It is essential to understand that these infants have neurobehavioral dysfunction with disorganized behavior rather than adaptation problems. Because of this, individualizing the non-pharmacological care specific to the infant may be beneficial. Health care professionals should involve the mother and help her identify these interventions that alleviate the dysfunctional behaviors specific to her baby.
Option D: Teaching the mother to provide for early infant stimulation is incorrect because he is irritable and needs quiet and little stimulation at this time. Techniques such as gentle vertical rocking, side-lying C-position, containment with hands held, swaddling, and swaying can be soothing and may help reduce irritability and hypertonicity. Avoiding unnecessary tactile stimuli by clustering care and providing skin to skin is effective.