INFANTS BORN WITH FENTANYL ADDICTION
Fentanyl is a highly potent synthetic opioid. It changes how your body perceives and responds to pain by acting on the brain. It is a prescribed medicine that is also illegally manufactured and consumed. This medicine is used to treat severe chronic pain (such as due to cancer). It is also used to treat chronic pain sufferers who are physiologically resistant to other opioids.
Fentanyl, like heroin, morphine, and other opioid medications, operates by attaching to opioid receptors in the body, which are present in parts of the brain that govern pain and emotions. After repeated use of opioids, the brain adapts to the medication, decreasing sensitivity and making it difficult to feel pleasure from anything other than the drug. Drug seeking and usage take over a person's life when they get hooked. Tolerance develops when you require a greater and/or more frequent dose of a medicine to achieve the intended effects. People who get addicted to fentanyl and quit taking it might experience severe withdrawal symptoms as soon as a few hours after the last dose. Among these signs are:
Discomfort in the muscles and bones
Sleep issues
Vomiting and diarrhea
Goose bumps and chilly flashes
Leg motions that are uncontrolled
Extreme urges
These effects may be quite unpleasant, which is why many people find it difficult to stop using fentanyl.
WHAT HAPPENS WHEN AN INFANT IS BORN WITH FENTANYL ADDICTION?
When newborns are exposed to drugs in the womb before birth, they develop neonatal abstinence syndrome. Following delivery, babies may experience medication withdrawal. The condition is most commonly associated with opioid medications. Prenatal opioid exposure has increased as a result of growing prescription opioid usage as well as the existence of both illicit opiates and opioid-substitution therapy. Infants are more vulnerable to signs of abstinence or withdrawal, which may necessitate evaluation and treatment.
TREATMENT
A number of factors contribute to the successful supportive management of infants exposed to opioids during pregnancy, including providing appropriate medication(s), correct scheduling, using a precise tool to measure and evaluate the severity of symptoms, constructing a compatible physical environment, and having a knowledgeable, experienced health care team. Involving interprofessional team members (e.g., nurses, neonatologists, social workers, pharmacists, nutritionists, and community resources) is critical for enabling the smooth treatment and discharge of these fragile newborns. The treatment aims include minimizing NAS problems and restoring typical newborn behaviors such as sleep, adequate eating, weight gain, and environmental adaptability.
Because medical measures might extend hospitalization, disturb mother-baby connection, and introduce a newborn to medicines that may not be essential, the first therapy for neonatal withdrawal should be mostly supportive.
Non-pharmacological therapies have been demonstrated to minimize withdrawal symptoms and should be applied as soon as feasible after delivery. Skin-to-skin contact, safe swaddling, gentle awakening, a calm atmosphere, limited stimulation, reduced lighting, developmental positions, music, or massage treatment are examples of supportive interventions.
Infants with NAS may exhibit eating difficulties such as excessive non-nutritive sucking, poor feeding, regurgitation, and diarrhea. An early research discovered that opioid-exposed newborns had greater feeding issues than non-drug exposed infants (rejecting the breast, spilling milk, hiccoughing, spitting up, and coughing). More recent research have supported these findings and discussed the difficulties carers experience while feeding infants who exhibit withdrawal symptoms. For newborns with inadequate weight growth, supplementation with concentrate to enhance calorie intake or total fluid intake has been proposed.
Pharmacological medication is recommended for newborns whose withdrawal symptoms worsen or whose concurrent NAS score rises despite supportive interventions to minimize and control symptoms. This strategy for treating babies with NAS employs a symptom-based, rather than a weight-based therapy regimen. Many clinicians prefer to provide medications to babies depending on their weight. However, the NAS spectrum of physiologic and behavioral symptoms is very variable, much more so than newborn birthweight, as are the frequent changes in infant withdrawal status that occur in such infants. As a result, treating this disease with increasing dosages of opioid replacement medicine until a controlled plateau of symptom manifestation is reached becomes a more practical option. Furthermore, medication dosing depending on infant weight is likely done to achieve a specified plasma level of drug to alleviate symptoms of NAS. Infants who need pharmacological treatment may need to be admitted to a special care nursery or NICU for cardiorespiratory monitoring and surveillance while therapy is commenced, especially if they are medically unstable. A stable newborn can be placed back into a care-by-parent area (e.g., rooming-in) as long as continuing evaluation, parent education, and medication weaning monitoring are in place, infant-mother bonding is fostered, and complete discharge planning can begin. Breastfeeding and rooming-in with moms on a methadone program have been demonstrated to lessen the need for pharmaceutical intervention. According to the American Academy of Pediatrics, medication selection should be based on the type of agent producing withdrawal. Morphine and methadone continue to be the most often used first-line medicines. Medications: Buprenorphine and methadone reduce cravings and withdrawal symptoms by binding to the same opioid receptors in the brain as fentanyl. Another medication, naltrexone, inhibits the action of fentanyl by blocking opioid receptors. This examination and treatment strategy should be characterized as a proposal for best care of the opioid-exposed baby. Individualized discharge planning should include a referral to a primary health care practitioner who is experienced with pharmaceutical therapies for opiate withdrawal, nutritional and family supporting resources, and an assessment of newborn neurodevelopment.
