Caring for the Infant with Neonatal Abstinence

Syndrome (NAS) According to the American Academy of Pediatrics (2012), nonpharmacologic care strategies should comprise the initial approach to therapy in treating Neonatal Abstinence Syndrome.

NAS is a self-limiting condition where the primary goal of the care team is to decrease symptoms without extraneous pharmacological and medical intervention. Successful

management of neonatal withdrawal symptoms rests on a foundation of supportive care for mother and infant, with active participation from a multi-disciplinary care team. Evidence-based strategies include providing a calm environment with decreased visual and auditory stimuli, promoting sleep for parents and infant, providing positive proprioceptive and tactile

sensory input, and maximizing nutrition to promote weight gain. Ideally, infant and family remain together for the duration of the hospital stay in a quiet, protected environment with

medical and psychosocial support that continues beyond hospitalization.

Provided as a courtesy by Dandle•LION Medical www.dandlelionmedical.com 203-791-9001Provided as a courtesy by Dandle•LION Medical www.dandlelionmedical.com 203-791-9001

Dandle•LION products provide supportive care for infants with NAS

American Academy of Pediatrics (2017). Alternative treatment approach for neonatal abstinence syndrome may shorten hospital stay. AAP News. Accessed online September 4, 2018 at http://www.aappublications.org/news/2017/05/04/PASNAS050417Brogan, J. & Rapkin, G. (2017) Implementing evidence-based neonatal skin care with parent-performed, delayed immersion baths. Nursing for Women’s Health, 21(6); 4420450. doi: 10.1016/j.nwh.2017.10.009Casper, T. & Arbour, M. (2014). Evidence-based nurse-driven interventions for the care of newborns with neonatal abstinence syndrome. Advances in Neonatal Care, 14(6); 376-380. doi: 10.1097/ANC.0000000000000118Cleveland, L. & Bonugli, R. (2014). Experiences of mothers of infants with neonatal abstinence syndrome in the neonatal intensive care unit. Journal of Obstetric, Gynecological and Neonatal Nursing, 43(3); 318-329. Department of Health and Human Services & National Institutes of Health (2016). Substance use in women. National Institute of Drug Abuse Research Report Series. Edraki, M., Paran, M., Montaseri, S., Razavi Nejad, M. & Monstaseri, Z. (2014). Comparing the effects of swaddled and conventional bathing methods on body temperature and crying duration in premature infants: a randomized clinical trial. Journal of Caring Science, 3(2); 83-91. doi: 10.5681/jcs.2014.009Grossman, M. et al. (2017). An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics, 139(6). Grossman, M., Minear, S., Whalen, B. & Wachman, E. (2017). Eating, sleeping, consoling (ESC) neonatal abstinence syndrome (NAS) care tool. Instructional Manual, 1st ed. Boston Medical Center Corporation and Children’s Hospital at Dartmouth-Hitchcock.Happiest Baby, Inc. (Karp, H., & Starlight Home Entertainment Firm). (2002). The happiest baby on the block [DVD videorecording]: The new way to calm crying and help your baby sleep longer ([Full screen format].). [United States]: Happiest Baby, Inc.

Holmes, A., Atwood, E. Whalen, B. Beliveau, J., Jarvis, J., Matulis, J. & Ralston, S. (2016). Rooming-in to treat neonatal abstinence syndrome: Improved family-centered care at lower cost. Pediatrics, 137(6), e1 – e8. doi: 10.1542/peds.2015-2929Hudnak, M. & The Committee on Drugs and The Committee on Fetus and Newborn. (2012). Clinical report: neonatal drug withdrawal. Pediatrics, 129; e540.Maguire, D., Rowe, M., Spring, H. & Elliott, A. (2015). Patterns of disruptive feeding behaviors in infants with neonatal abstinence syndrome. Advances in Neonatal Care, 15(6); 429-439. doi: 10.1097/ANC.0000000000000204Milford, C. (2017). Psychosocial support for perinatal substance use mothers and their newborns. Neonatology Today, 12 (2); 7-9. Moore, D., Turner, J., Parrott, A., Goodwin, J., Fulton, S., Min, M… Singer, L. (2010). During pregnancy, recreational drug-using women stop taking ecstasy (3,4-methylenedioxy-N-methylamphetamine) and reduce alcohol consumption, but continue to smoke tobacco and cannabis: initial findings from the development and infancy study. Journal of Psychopharmacology, 24(9); 1403-1410. doi:10.1177/0269881109348165Murphy-Oikonen, J., Brownlee, K., Montelpare, W. & Gerlach, K. (2010). The experiences of NICU nurses in caring for infants with neonatal abstinence syndrome. Neonatal Network, 29(5); 307-313.Reece-Stremtan, S., Marinelli, K. & The Academy of Breastfeeding Medicine. (2015). ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeeding Medicine, 10(3); 135-141. doi: 10.1089/bfm.2015.9992Smith, C., Roll, J. & Fleming, S. (2016). Nurses’ perceptions of caring for childbearing women who misuse opioids. The American Journal of Maternal/Child Nursing. doi: 10.1097/NMC.0000000000000208The Joint Commission (2016). Managing neonatal abstinence syndrome. Quick Safety (27).

Therapeutic Positioning The DandleWRAP Stretch is designed to support irritable, hard-to-console babies. The lightweight, moisture-wicking fabric reduces discomfort from overheating and sweating. The high-performance material allows movement while providing 360-degree proprioceptive input, mimicking the intrauterine environment through calming containment. The degree of containment can be customized with hook and loop tabs.

The Cozy Cub is a weighted bean bag positioner that provides extra stability and security for irritable infants. It can be molded and moved to provide containment and functionality where the baby needs it most.

Skin Protection Preventing diaper dermatitis is essential to promoting comfort in babies with NAS. Frequent stooling can change the pH of the baby’s skin, increasing the risk of irritation and breakdown. Diaper Balm prevents discomfort and brings soothing relief to severely chapped, cracked or irritated skin. A barrier of zinc, tea tree oil and organic calendula battle bacteria and seal out wetness. Zinc is the most effective barrier ingredient because it does not enter the blood stream. All other ingredients in Diaper Balm are organic and plant based.

Therapeutic Touch Infant massage provides babies with a positive tactile experience that promotes proprioception and encourages development of a sense of “self”. Nurturing Massage Oil was developed for the most sensitive skin and the pH balanced complex of organic ingredients create an ideal glide for massage. The specifically selected and clinically proven oils are rich in essential fatty acids and nutrients.

Protective Environment Swaddled, immersion bathing promotes temperature stability and creates a relaxing and calm experience for irritable babies. Swaddled bathing has been shown to decrease crying and increase parental involvement. The DandleLION Bathing System allows parents and staff to safely and easily provide a calming, nurturing bathing experience. Care providers may feel less hurried and parents may feel more confident providing swaddled baths.

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