The Neonatal Abstinence Syndrome (NAS) is an important and significant morbidity in the Neonatal period. In this case report, we described a case off opum addiction infancy period 5 months old. Her mother prescribed the oral opium to her for prevention of symptoms of NAS. We also discus differential diagnosis and management of such discuss.

Background: The Finnegan scoring system which is used to initiate and guide Neonatal Abstinence Syndrome (NAS) therapy has several limitations that make it difficult to be used by manyhealthcare providers. Therefore in practice manyexperienced clinicians use their clinical judgements for initiating and continuation of NAS treatment. Objectives: Assessing the degree of association between clinical judgments of experienced neonatologists and the Finnegan scoring system to initiate NAS treatment, and identifying the most prevalent items of the Finnegan scoring system which are independently associated with the need for NAS treatment. Methods: This multi-centric prospective cohort study evaluated 60 admitted neonates who were born to illicit drugs dependent mothers and exhibited signs and symptoms of NAS. Neonates were evaluated based on the Finnegan scoring system once at birth and every four hours. Three consecutive Finnegan scores of  8 or two consecutive Finnegan scores of  12 were considered as the requirement for treatment with morphine. Five expert neonatologists with > 15 years of experience, who were blinded to the Finnegan score results visited the patients and their clinical judgments for initiating the medical treatment for NAS were recorded. Results: Based on the Finnegan scoring system 26. 7%, and based on the clinical judgment 30% of neonates required medical treatment. There was an excellent correlation between Finnegan scoring system and clinical judgment of experienced neonatologists (r = 0. 75, P < 0. 001), which was highly sensitive (87. 5%) and specific (90. 9%) in detecting neonates with NAS who required medical treatment. Tremor (P < 0. 001), convulsion (P = 0. 001), projectile vomiting (P = 0. 001), increased muscle tonicity (P = 0. 02), tachypnea (P = 0. 04), and poor feeding (P = 0. 04) were the items of the Finnegan score that regardless of their severity were independently associated with the requirement for pharmacologic treatment. Conclusions: In special circumstances when using Finnegan scoring system in regular basis is not applicable, initiating NAS treatment based on the clinical judgments of expert neonatologists can be acceptable. Tremor, convulsion, increased muscle tonicity, tachypnea, projectile vomiting, and poor feeding can be used for screening neonates after birth for early identification of opioidexposed infants who might require medical treatment.

Background: The Neonatal Abstinence Syndrome (NAS) has been treated so far by various drugs, such as opioids and non-opioids. There is some concern about NAS babies who receive chemical drug treatment. Some researchers mentioned that shorter pharmacological treatment and less lengthy hospitalization are associated with several secondary advantages. The aim of this study was to assess safety, tolerability, and efficacy of acupuncture in management of Neonatal Abstinence Syndrome in infants. Materials and Methods: An extensive search was done in databases of Medline, EMBASE, Scopus, Cochrane, and Web of Science until August 2018. Two independent researchers screened articles, in the next step, full texts of probably relevant articles were summarized and categorized based on the evaluated outcomes and overall effect size was presented. Results: Five studies were included in the systematic review. Auricular acupuncture when implemented as adjunct pulse non pharmacologic in management of NAS is safe, feasible, and acceptable. However, Auricular acupressure did not show any significant effect on pharmacological therapy, length of hospital stay and average NAS scores. Treatment with Laser acupuncture as adjunct in management of infants with NAS were associated with several advantages. These include improvement in feeling (better relaxation and higher calorie intake), decreased Finnegan scores, shorter duration of treatment with morphine, and shorter duration of hospitalization. In terms of safety, treatment with laser acupuncture as adjunctive were well-tolerated. Conclusion: The findings of this systematic review showed that infants with NAS secondary to maternal opiate usage may receive more benefits of treatment with acupuncture in combination with pharmacologic therapy compared to pharmacologic therapy alone. In these findings should be interpreted in light of mentioned limitation.

Neonatal thrombocytosis is a very rare phenomenon in infants born to addict mothers. It can be due to opioids withdrawal and occurs a few days after delivery. The etiology is unknown and it is eradicated gradually without any complication.The reported neonate was born to a heroin addict mother who has used methadone during pregnancy. The neonate was admitted in 14th day of life in Neonatal intensive care unit (NICU) with the diagnosis of withdrawal Syndrome and supportive care was administered for him. Thrombocytosis was detected in routine lab tests. There was not any reason for it except his mother’s addiction. The platelet count was 1,168,000 in the first day and decreased gradually during 28 days to 739,000. There was not any complication and no special treatment was administered. This case indicates that thrombocytosis may happen as a part of Neonatal Abstinence Syndrome and is eradicated without any complication. 

Background: The experience of having neonates in the Neonatal Intensive Care Unit (NICU) is a psychological crisis. It might cause many emotional problems for parents. Entire parental support is among the duties of the healthcare team. Therefore, this study aimed to compare the nursing support received by the mothers with Newborn Abstinence Syndrome (NAS) and the mothers of other neonates admitted to the NICU. Methods: The present cross-sectional descriptive-analytic study was conducted in the selected hospitals in Kerman Province, Iran. In total, 62 mothers with NAS and 61 non-addicted mothers with neonates admitted to the NICU were selected through convenience sampling method. The inclusion criteria were neonates under the care of parents, neonate admitted to the NICU for at least 24 hours, opiate dependence in the case group mothers, and no substance dependence in the control group mothers. The amount of nursing support for mothers having neonates with NAS was compared with that of the control mothers. The study groups were homogenized in terms of the study variables (neonate age, gender, and the duration of hospitalization). The required data were collected by the Nurse-Parent Support Tool (NPST) and analyzed in SPSS. Results: The study results revealed that among the neonates of 123 mothers, 75 (60. 97%) were boys, and 58(39. 02%) were girls. The majority of neonates in both groups were breastfed. The Mean± SD age of the mothers in the case and control group were 31. 93± 7. 25 and 28. 99± 4. 36 years, respectively. The nursing support level was desirable in both groups, and no significant difference was found in this regard (P>0. 05). Furthermore, the level of nursing support in emotional, information-communication, self-esteem, and quality caregiving support dimensions was desirable in both groups. Conclusion: The obtained results revealed that nurses’ support was desirable in both groups. The prevalence of maternal addiction and the impact of this social harm on neonates who were admitted are essential. Furthermore, families having neonates with NAS need more support from the healthcare staff and nurses, in comparison with healthy parents; thus, the importance of this issue should be addressed in training and briefing courses for nurses.

Background: Congenital heart defects (CHDs) are the most common congenital malformations at birth. Substance abuse has increased dramatically over the past two decades. It also can affect neonates of drug-abusing mothers. Objectives: This study aimed to elucidate the possible association of maternal drug abuse with CHDs in their newborn infants. Patients and Methods: In this study, 72 neonates who were born during 6 years in three teaching hospitals are studied. Echocardiography was performed by a single pediatric cardiologist using two-dimensional and color Doppler echocardiography. The data were analyzed using descriptive statistics. Results: 1) Of 72 included cases, 38 (52. 78%) had abnormal echocardiographic findings; 2) from 38 abnormal echocardiography, 35 (48. 61% of total and 92. 11% of abnormal echoes) had mild congenital heart defect (CHD), and 3 had complex CHD; 3) There was no significant difference in the prevalence of Neonatal congenital heart defect with the type of misused drugs (opiates or methamphetamines). Conclusions: In our study, the prevalence of CHD in newborns of drug abuser mothers was significantly higher than the normal population of infants. Hence, echocardiographic screening of these newborns seems to be logical.