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## Careful Monitoring * Surgical removal of 85-90% of the pancreas may be needed for infants to reduce insulin, but poses risks of diabetes. ## Fetal Exposure to Drugs ### Heroin * Heroin use by the mother has a profound effect on the fetus and the neonate. * Infants with prenatal heroin expos...

## Careful Monitoring * Surgical removal of 85-90% of the pancreas may be needed for infants to reduce insulin, but poses risks of diabetes. ## Fetal Exposure to Drugs ### Heroin * Heroin use by the mother has a profound effect on the fetus and the neonate. * Infants with prenatal heroin exposure display symmetric intrauterine growth restriction (IUGR) and are often born prematurely. * Sixty to 80% of these infants will undergo Neonatal Abstinence Syndrome (NAS). * Heroin has a relatively short half-life and symptoms of NAS typically begin 48-72 hours after delivery. * Different body systems are affected by NAS and include: * **CNS Dysfunction:** High-pitched cry, hyperactive reflexes, increased muscle irritability, tremors. * **GI dysfunction:** Poor feeding, periods of frantic sucking or rooting, vomiting. * **Miscellaneous Signs:** Frequent yawning, sneezing multiple times, sweating, fever, tachypnea. ### Withdrawal Symptoms * Fetal exposure to drugs such as opioids, methadone, cocaine, crack, and other recreational drugs causes withdrawal symptoms in about 60% of infants. * There are many variables which include the type of drug and extent and duration of maternal drug use. * For example, children may have withdrawal symptoms within 48 hours for cocaine, heroin, and methamphetamine exposure, but there may be delays of up to 2-3 weeks for methadone. * Short hospital stays after birth make it imperative that children at risk are identified so they can receive supportive treatment, particularly since they often feed poorly and can quickly become dehydrated and undernourished. * Polydrug use makes it difficult to describe a typical profile of symptoms, but they usually include: tremors, irritability, hypertonicity, high-pitched crying, diarrhea, dry skin, seizures (in severe cases).