Drug Exposed Infants - Vulnerable Populations and Self-Awareness

Vulnerable Populations and Self-Awareness

Drug Exposed Infants

Vulnerable Populations and Self-Awareness

The vulnerable population chosen for this paper is the infants of mothers who take drugs. This group includes infants of mothers who take addictive drugs like heroin, cocaine, crack, etc, alcohol, prescribed drugs taken for recreation, and methadone. Any drugs taken during pregnancy can and usually will affect infants. Neonatal drug addiction occurs when the mother uses drugs during the pregnancy. These drugs cause abnormalities in the infant. Signs and symptoms of an infant's drug dependence vary and may include multiple physical and behavioral changes.

I have worked in neonatology for 33 years caring for premature and ill term infants. Over these years, the number of drug exposed infants has increased noticeably. In the beginning, at least once every few months a drug exposed infant would be born. The usual hospital stay was two to four weeks because of drug withdrawal symptoms and care. In the past few years, there have been an increased number of infants admitted for drug exposure. At most, there would be one drug addicted infant in a unit with a census of 50-55 patients in previous years. Over the past two years, there have been a minimum of two infants in active withdrawal with two other drug exposed infants in the process of going home. Hospital stays have increased to months instead of weeks. These infants exhibit signs and symptoms that require a longer periods between weaning the methadone dose. These infants also require more frequent handling and calming techniques than normal term or premature infants. Feeding and growth issues have become big problems for these infants. "Methadone on a maintenance schedule during pregnancy is used to reduce many of the negative outcomes of illicit drug use through substitution of an illicit substance of uncertain composition and dose (heroin) with a pure substitute at a stable dose (methadone)" (Burns, Mattick, Wallace, p. 265). Infants whose mothers took methadone plus other substances as well as mothers on only methadone now seem to need longer stays for treatment (Johnson, Greenough, Gerada, 2003).

I am typically a primary nurse or consistent caregiver of any of the infants considered chronic patients--those who have been in the unit for more than four weeks or are past term (40 weeks gestational age). Chronic infants/older infants need a different kind of care than newborns and premature infants. Developmental care starts to take an important role in their care so that they start to advance in development. Many drug exposed infants at the age of two months do not turn over or smile because their irritability makes their caregivers do whatever it takes to keep them from screaming. The knowledge of why they scream, how to calm them and how to teach them to calm themselves makes their care easier. When the nurses learn how to handle these infants, the health care they receive runs smoother and methadone weaning is easier.

Many nurses have a difficult time caring for the drug exposed infant and family. The parents have multiple issues--medical, financial, and social. The family does not always have all of these issues. Some parents are financially very stable and well-off financially. These parents are sometimes professionals who have gotten into the social or recreational aspect of drug use. Some parents are homeless and live on the streets or in shelters. Occasionally both parents are drug users. There has recently been an increase in drug exposed infants who have fathers who do not use drugs and eventually take custody of their child. Some parents become violent and visit in a "high" condition. These incidents make