Assessment of the Normal Newborn PDF

Assessment of the Normal Newborn Marianne Barker, MSN, RN, CHSE, CNE Nursing 313 Endicott College Cummings School of Nursing   Discuss early focused newborn assessments- Maternal/pregnancy history,...

Assessment of the Normal Newborn Marianne Barker, MSN, RN, CHSE, CNE Nursing 313 Endicott College Cummings School of Nursing   Discuss early focused newborn assessments- Maternal/pregnancy history, thermoregulation, cardiopulmonary status  Normal versus abnormal We will assessment findings with head-to-toe discuss… assessment  Apply the nursing process to the head-to- toe assessment  Describe newborn behavior with assessments  Immediate Care  Review Pregnancy History/Patient Chart  Remember your ABC’s!! Airway Breathing Circulation  Thermoregulation  APGAR  Initial Assessment  Identification/Safety  Bonding  Newborn Medications  Pregnancy History Early Respiratory Status Focused Newborn Cardiopulmonary Status Assessment Thermoregulation  Perinatal History- Patient Chart Review  Family History  Maternal Medical History  Obstetric History  Social History  Pregnancy History  Labor and Delivery  Newborn Resuscitation  Perinatal History Family History: Maternal Medical History: Inherited Diseases General Health (age, BMI) Chronic Disorders Chronic Illness (cardiac) Surgical Procedures Social History: Medications before and during Pregnancy Marital Status Financial Educational Obstetrical History: Drug, alcohol, tobacco use History Infertility Domestic Violence Previous pregnancies Religious/Cultural Birth weights Primary Language Previous fetal demise Airway  In utero, respiratory tract is filled with fluid  During vaginal delivery, fluid is forced out with compression of fetal chest passing through vagina  As head is delivered, mouth and nose excess mucous will be wiped off and mouth/nose may be suctioned with a bulb syringe  Immediately after delivery, further suctioning is performed as needed  Vigorous suctioning in a normal newborn is not needed Bulb Suction  Compress bulb before insertion, release bulb to create suction after insertion.  Keep head lower than body to promote drainage of secretions  Suction mouth, then nose  Suction gently 5-10 sec max  Avoid deep suctioning with bulb…  can cause bradycardia from vagal stimulation  can stimulate gag reflex  Respiratory/ Cardiopulmonary Status Airway- crying (tactile stimulation), suctioning (mouth then nose), meconium, clear airway before using oxygen Respiratory Rate- Normal Respiratory rate=30-60 breaths per minute Breath sounds  Auscultate anteriorly and posteriorly-should be equal  Sounds of moisture for the first two hours of life is common, more with C/sections  Report any abnormal sounds to provider Normal Neonatal Vital Signs  Temperature – axillary 97.7– 99.5º F  Heart Rate – 120 – 160/min at rest apical  May be higher while crying  Some sources say 110 is lower limit of normal  For a short period of time, pulsation can be felt at umbilical cord  Respirations 30 – 60/min at rest, irregular  BP is typically not done on newborns  Thermoregulation  Heat loss occurs quickly  Newborn has limited ability to compensate  Non-shivering thermogenesis  Brown fat accumulates in third trimester  Metabolismof brown fat produces heat  Bloodflow passing through brown fat is warmed  Thermoregulation  Temperature is taken within the first 30 minutes after birth  Axillary-normalrange=  97.7-99.5F / 36.5-37.5 C  IMPORTANT TO REPORT/DOCUMENT ABNORMAL TEMPS! Can be taken rectally is axillary is out of range Prevention of heat loss Dry infant thoroughly, especially hair Remove wet blankets Skin to skin contact with mother Cover with warm, dry blankets Apply a hat Use radiant warmers if needed Thermoregulation  Respirations  A crying infant is a breathing infant!  Stimulate infant to cry after secretions removed  The process of drying itself may stimulate crying  Rub back  Rub soles of feet  Cry should be loud and lusty  Keep nares patent – infants are nose breathers  Signs of Respiratory Distress in the Newborn  Tachypnea=increased respiratory rate- greater than 60 bpm  Retractions  Cyanosis=Central-including lips, mucosa, trunk *Acrocyanosis-blue hands and feet-normal finding*  Grunting  Nasal Flaring  Choanal Atresia-narrowing or blockage of nasal passages  Asymmetry in rising of chest-should be equal-if not, may be indicative of pneumothorax  Mewing  ALL SHOULD BE REPORTED TO PROVIDER!  Nursing Assessments  Periodic Breathing=pauses in breathing Last 5-10 seconds without other physiologic changes occurring Followed by rapid respirations lasting 10-15 seconds Periodic breathing is normal finding  Apnea A pause in breathing lasting 20 seconds or more Accompanied by cyanosis, bradycardia Apneic breathing is an abnormal finding  Heart Sounds Heart Sounds are auscultated for: Rate Rhythm Murmurs/Arrythmias Heart sounds are auscultated for 1 full minute apically Normal Heart rate=120-160bpm at rest 160-180bpm when crying 100bpm at rest/sleeping Heart Sounds-Nursing Assessment Apical pulse Point of maximum Impulse-where the pulse is most easily auscultated- typically located at the 3rd-4th intercostal space lateral midclavicular line Other pulses: Brachial Femoral Assess capillary refill-normal is 3-4 seconds  Cardiopulmonary distress Labored breathing: Absent or weak cry retractions, Floppy despite stimulation flaring, grunting on expiration, stridor Bradypnea or Bradycardia or Central cyanosis tachypnea tachycardia Asymmetrical Crackles persisting Coughing, sneezing chest expansion beyond 1-2 hours normal Normal Newborn Color  APGAR A =Appearance (color) P=Pulse G =Grimace (reflex) (response to stimulation) A=Activity/muscle tone R=Respirations/respiratory effort Interpretation of Apgar scores Remember: Resuscitation does not wait for Apgar scores 0-2 Infant need resuscitation 3-6 Infant needs support – remove meconium, stimulate respirations, administer oxygen, assess need for naloxone (Narcan) 7-10 No intervention needed, continue to observe What Apgar would you Assign?  https://www.youtube.com/watch?v=851ybWmDbio  https://www.youtube.com/watch?v=89PpgbyPZiE Try these for practice~  Bonding  Physiologic needs come first  Bonding: development of a strong emotional tie from parent to newborn  Infant: first period of reactivity – alert, eyes wide open, seems to focus on face and voice of parents, grasp reflex, ready to breastfeed  Mother & father: touch progresses from fingertips to stroking to enfolding, identification of features  Ability to have tactile interaction immediately after delivery is felt to promote bonding  Initiate breastfeeding  Benefits of early initiation of breastfeeding:  Associated with higher breastfeeding continuation rates  Benefits of colostrum begin immediately  Stimulates milk production  Facilitates bonding  Aids in uterine contraction  Newborn  First reactive state – very alert  Suck, swallow reflex present at birth  May suckle, suck intermittently or just nuzzle  Expanded assessment  Vital signs every 30 min for first 2 hours after birth BP not usually taken on otherwise healthy baby Temp: axillary or by skin probe  Respirations and apical pulse counted for 1 full minute at rest  Head to toe assessment for obvious abnormalities & gestational age, done under warmer  Weight, length, head & chest circumference  Observe for first void and stool  Assess maternal/infant interactions  Circumcision Male circumcision is the surgical removal of the foreskin, which is the layer of skin that covers the head of the penis. Circumcision may be performed before or after the mother and baby leave the hospital. It is performed only if the baby is healthy. If the baby has a medical condition, circumcision may be postponed. It is not required by law or by hospital policy. Because circumcision is an elective procedure, it may not be covered by health insurance policy. Performed by OB/GYN  Circumcision Care If a baby boy circumcised, you will need to care for his penis as it heals.  With each diaper change, the penis should be thoroughly cleansed and petroleum jelly placed over the wound.  The jelly can be placed on a gauze pad and applied directly on the penis or placed on the diaper in the area the penis touches.  In most cases, the skin will heal in 7–10 days. You may notice that the tip of the penis is red and there may be a small amount of yellow fluid. This usually is a normal sign of healing.  Watch for a void post procedure. Newborn needs to void prior to discharge  Assess for increased bleeding-Notify provider  Assess if vitamin K has been administered prior to procedure  Cord care  At the time of delivery, the provider clamps and cuts the cord & obtains cord blood for testing and possibly banking  Nurse may trim cord later  Assess for bleeding in first few hours  Goal to keep stump clean and dry - fold diaper down, leave exposed to air, clean with water or alcohol  Risk for infection 48-72 hrs – Signs: purulent drainage, foul odor, redness or edema at base  Dries, turns brownish/black after 2-3 days, falls off within 10-14 days Ophthalmia Neonatorum prophylaxis  Prevents conjunctivitis acquired during birth (gonorrhea and to a lesser degree, chlamydia)  Prophylaxis within 2 hours of birth required by MA law  Erythromycin ophthalmic ointment 0.5% most commonly used locally  Tetracycline 1% ophthalmic ointment Erythromycin administration  Apply thin strand of ointment along lower lid from inner to outer  Can cause transient blurred vision – delay until after first hour if appropriate  Assess for hypersensitivity  Parental refusal requires signed waiver  Vitamin K  Required for synthesis of clotting factors  Synthesized by bacterial flora in colon (newborns have little to no flora)  Breastmilk is not a source  Does not cross placenta  Neonates at risk for Vitamin K deficiency bleeding (VKDB) until food ingested & bacteria colonize the gut  One time administration (IM) within 1-2 hrs of birth recommended for all newborns  Especially important before circumcision  Parental refusal requires signed waiver  Hepatitis B  Newborns can become infected from exposure to infected maternal blood  Immunization for Hep B is included with other routine childhood vaccinations  Vaccine often given within 2 hours of birth with other newborn meds  Parental refusal requires signed waiver  Hepatitis B  Hepatitis B negative mother: administer 0.5 mL hepatitis vaccine IM before discharge  2nd and 3rd doses in 1-2 and 6-18 months by pediatrician  Hepatitis B positive mother:  administer 0.5 mL of hepatitis vaccine and 0.5mL Hepatitis B Immune Globulin (HBIG) IM into separate sites within 12 hours of birth  Review: Newborn Injection technique For all newborn injections: Use vastus lateralis site Max volume 0.5 mL 25 gauge, 5/8 in needle Wash thigh before cleansing with alcohol Stabilize leg so infant does not inadvertently move  Video Newborn Stabiliz ation and Care  Nursing Assessments: Key Points Respiratory rate should be counted for one full minute Chest movements should be asymmetrical Breath sounds should be clear and unlabored Assessment of respirations includes observation, auscultation, palpation Assess newborn color-normal pink skin Pallor-may indicate hypoxia or anemia Ruddy (reddish)-Polycythemia-increase in red blood cells. Blue-life threatening respiratory distress- circumoral cyanosis-blue around the mouth General Newborn Assessment Literally from head to toe Includes weight, length, APGAR Includes vital signs-heart rate, respiratory rate and temperature Includes-skin, head, face, neck, clavicles, vertebral column, extremities, abdomen, hepatic genitalia, nervous system, sensory (reflexes) Done within the first few hours of life  Measurements Weights. Normal range-2500g-4000g (5lbs 8oz-8 lbs 13oz) Weighed daily at the same time 10% lose of birthweight in first week of life is normal Length Top of head to heel-leg must be outstretched Normal range-19-21 inches  Skin Assessments Color-pink, pale, Newborn skin is jaundice, blue, VERY fragile greenish-brown Mottling-lacy Vernix caseosa- red/bluish pattern thick substance- due to dilated like cream cheese- blood vessels nature’s lotion! under skin Milia-small white Lanugo-fine, soft cysts on nose, hairs face-disappear, normal finding  Skin Assessments  Erythema toxicum-Red blotchy areas AKA-”newborn rash”  Mongolian spots-bluish grey looks like bruising  Other types of birthmarks-nevus  Marksfrom delivery-bruising from precipitous delivery  Petechiae-pinpointbruising resembling a rash-may indicate infection Skin Assessments  Head Assessments HEAD  HeadCircumference-normal range-32-38 cm (13-15 inches)  Molding-changes in the shape of the head that allow it to pass through the birth canal  Fontanels Fontanels-areas of the head where sutures between the bones meet together Anterior: diamond shaped-where parietal and frontal bones meet. About 4-6 cm bone to bone, Closes by 18 months Posterior: triangular-shape where occipital and parietal bones meet. About 0.5cm size, closes by 2months Fontanels should be soft and flat. Depressed fontanels may indicate dehydration Bulging fontanels may indicate increased intracranial pressure  Head Assessments Caput Succedaneum- area of localized edema over vertex of the head from pressure during labor. Present at birth Soft but vary in size Resolves quickly Cephalhematoma-bleeding between the periosteum and the skill as a result of pressure during birth Occurs on one or both sides of the head Mostly seen over parietal bone Reabsorbs slowly (up to 2 months) Greater risk for jaundice  Head/Face Assessments  Face-assessed for symmetry, facial feature positioning, movement and expression  Ears-well formed and complete-eyes in line with top of ear  Eyes-sclera is white, no tears, no discharge blinking present, equal in size, Iris is gray  Eyes-Strabismus-lack of eye muscle coordination  Nose-nasal patency, no flaring of nostrils  Inspected visually and palpation Mouth Teeth Assessment Palate-intact with high arched palate Frenulum of tongue Sucking reflex Swallowing Thrush-infection of the mucous membranes  Neck-note the ease at which the head can turn from side to side Clavicles-intact Neck, Chest Respiratory effort-chest and abdomen rise/fall together and Clavicles Breath sounds-equal bilaterally, crackles Chest Circumference-normal range- 30-36cm (30-36 inches), measure at nipple line  Assessed visually, palpation and auscultation Should be soft and round, non distended Abdomen Audible bowel sounds and Umbilical cord-clamped, dry, no Umbilical bleeding Cord 3 vessels-2 arteries, 1 vein (AVA) Wharton’s jelly Umbilical Cord  Normal Blood Glucose at birth- 40-60mg/dL Normal for term infants after first day of life-50-90mg/dL Hepatic- Blood Risk Factors of hypoglycemia: Glucose Pre-Post term Late preterm infant Cold stressors Maternal Diabetes LGA-Large for Gestational age infant SGA-Small for Gestational age infant  Blood Glucose Signs of Hypoglycemia: Jitteriness/tremors Decrease in muscle tone Grunting Poor sucking reflexes Low temperature Lethargy, listlessness Irritability Tachypnea/Tachycardia Seizure activity  Monitoring Blood Glucose Infants at risk for hypoglycemia are monitored for at least 24-48 hours after birth Treatment: If blood sugar is 40-50mg/dL or less- (check hospital policy): Infant is fed to prevent further decrease in level Glucose level is rechecked 30-60 minutes after feeding.  Bilirubin  Jaundice can set in 24-48 hours after birth  Bilirubin is hemolyzed (broken down) erythrocytes  Appears yellow as it builds up under the skin  Babies need frequent feeding to excrete the bilirubin  Bilirubin  Assess for jaundice every 8 hours  Good lighting is important  Press the infant’s skin over a firm surface  Jaundice starts from the head and works its way down the body  Documentation  Notify Pediatrician  Urine-voids within 12- 24 hours Anogenital Stool-Meconium Area within 12-48 hours Assessments Anus-patent, no rectal temps if not needed  Anogenital Area Female: Labia- large, slightly swollen looking Pseudo-menstruation-normal due to maternal hormones Discharge-white discharge is normal Male: Hydrocele-urethral opening at tip of penis Testes-palpable in each scrotum Scrotum-large, red Skeletal Structure Assessments  Back-gently rounded  SpinalColumn-Smooth without indentation/openings in vertebral column or pilonidal sinus, measure dimples for depth  Spine-straight and intact  Hips-Abduct equally, gluteal and thigh creases are equal, normal Ortolani and Barlow tests  Hip Dysplasia Developmental Hip dysplasia-Misalignment of the hip joints  Problem with the ball of the hip joint or the socket of the hip joint or both  Assess at birth  Risk factors-Hereditary, position while in utero, First born, females  Symptoms-reduced motion in hip, limited abduction, limp leg  Assessment-Holding the thighs within the had, with your index finger placed over the joint…toll legs up towards abdomen and flex outward Ortolani’s & Barlow’s Maneuvers  Safe Swaddling- To prevent hip dysplasia American Pediatric Association:  https://www.aappublications.org/ content/32/9/11.2  Legs-equal length Digits-ten separate fingers and toes Extremities Assessment Feet-aligned with leg, creases on the sole Movement-full range of motion all 4 extremities, symmetry, equal muscle tone bilaterally Femoral Pulses-equal and present Flexion-extremities in some degree of flexion, hands clenched  Reflexes Moro Palmar Grasp Plantar Grasp Nervous Sucking System Rooting Babinski Tonic Neck Stepping Watch Video on Canvas! Behavioral Changes Self-Soothing: Brings hands to mouth Sucking Listening to voices and sounds Watching objects Parental Response: Parents have growing ability to respond to infant’s behaviors in positive way  Documentation of Newborn Assessment  Descriptive and up to date documentation  A thorough and detailed newborn assessment can detect abnormalities quickly so that life saving interventions can be implemented. Remember…if not documented, it didn’t happen!  Newborn Marianne Barker, MSN, RN, CHSE, CNE NU 313 Complications Cummings School of Nursing  The Risk factors, newborn clinical manifestations, treatment and nursing priorities for the following complications: Prematurity/Preterm Birth Post-term Infant Meconium Aspiration Syndrome We will Macrosomia/LGA cover… Physiological and Pathological Jaundice Infection/Sepsis Spina Bifida Neonatal Abstinence Syndrome (NAS)/Drug Exposure  Prematurity/Preterm Birth Key facts: Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising. Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015 (1). Three-quarters of these deaths could be prevented with current, cost- effective interventions. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born. https://www.who.int/en/news-room/fact-sheets/detail/preterm-birth  Prematurity Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:  extremely preterm (less than 28 weeks)  very preterm (28 to 32 weeks)  moderate to late preterm (32 to 37 weeks).  Prematurity-Causes Preterm birth occurs for a variety of reasons including:  Early induction of labor or caesarean birth, whether for medical or non-medical reasons.  Multiple pregnancies,  Infections  Maternal chronic conditions such as diabetes and high blood pressure  Genetic influence  Bleeding  PPROM  Post-term Birth  A post term birth is defined as a birth at more than 42 weeks gestation  Incorrect due dates account for the majority of post term cases  The exact cause of post term birth is unknown: theory suggests a deficiency of estrogen and continued secretion of progesterone  A woman who has had one prolonged pregnancy is at greater risk for another in subsequent pregnancies.  Post term Pregnancy- Adverse Effects Maternal Risks: Fetal Risks: Large size of fetus at Macrosomia birth (Macrosomia) Shoulder Dystocia- Increase risk of brachial plexus nerve cesarean birth damage/injury Shoulder Dystocia Low APGAR score Birth Trauma Meconium aspiration Postpartum syndrome hemorrhage Oligohydramnious Infections MACROSOMIA  Post-term Birth-Nursing Assessment & Management  Obtain a thorough history to determine accurate EDB  Fetal kick counts  Ultrasound  Non stress tests  Biophysical profile  Assess patient stress and anxiety concerning the prolonged pregnancy  Assess patient coping abilities  Educate-possible surgical delivery  Infant Meconium Aspiration Syndrome Meconium Aspiration Syndrome-occurs when the newborn inhales meconium mixed with amniotic fluid into the lungs, either while in utero or when infant takes its first breath after birth.  Common cause of respiratory distress  Can lead to severe illness  Aspiration of meconium blocks the bronchioles, inducing airway obstruction, surfactant dysfunction and hypoxia  In severe cases, it progresses to persistent pulmonary hypertension and death. Meconium Aspiration Syndrome  Meconium Aspiration Nursing Assessments  Review prenatal records to identity high risk: Post-term delivery breech delivery vacuum extraction births smokers prolonged labor intrapartum fevers cesarean birth oligohydramnios placental insufficiency prolapsed cord   Assess amniotic fluid for meconium staining with rupture of membranes  Be prepared at delivery: Neonatologist, oxygen, suction, endotracheal tubes, stethoscope  Assess vital signs, lung sounds, Meconium oximetry, suction Aspiration  Observe the newborn for respiratory distress at delivery: Nursing barrel shaped chest Assessments tachypnea retractions grunting wheezing cyanosis  Group B Streptococcus (GBS)  GBS colonizes the vagina, rectum, and urethra in 15 – 40% of women  Not an STD  Usually asymptomatic and of no consequence to mother  Can cause maternal UTI or chorioamnionitis  Major risk is to fetus during delivery  Sepsis,pneumonia, meningitis may develop within 2 – 7 days  Prevention of GBS in Newborns CDC Guidelines  Treatment prior to labor ineffective  When admitted in labor, Penicillin G or Ampicillin IV every 4 hours until delivery  Best results when 2 doses have been given at least 4 hours prior to delivery  Cesarean birth prior to labor with intact membranes does not require treatment if mother is GBS +  Following CDC guidelines reduces the risk of GBS disease in infants from 1/200 to 1/4000  Group Beta Strep  Screening at 36-37 weeks gestation  Prophylactic IV antibiotic treatment to all women with a positive culture or unknown GBS status  Don’t want to give to early because re- infection is possible if given too soon Antibiotics used: Penicillin 5 million units IV for first dose then Penicillin 2.5 million units IV every 4 hours until delivery Ampicillin and Clindamycin are also options. Neural Tube Defects  Neural Tube defects- describe congenital central nervous system structural defects  Serious malformations including the spine and the brain  NTD are the second most congenital anomaly worldwide PATHOPHYSIOLOGY: The neural tube that develops into the brain and spinal cord fails to close properly Develop during the first month of pregnancy DIAGNOSIS: Alpha-fetoprotein levels in maternal serum is elevated at 16-18 weeks Ultrasound will then diagnose  Caudal defect (refers to below level of T12 in the spine) Incomplete development of the brain, spinal cord and their protective covering by the failure of the fetus’s spine to close properly during the first month of pregnancy. Spina Surgery can repair the opening after birth, but the nerve damage is permanent Bifida Various degrees of paralysis Leading cause of infantile paralysis  MSAFP-Maternal Serum Alpha-fetoprotein-or the MSAFP test, a maternal sample of blood. Protein produced by the baby It's typical for a small amount of AFP to cross the placenta and enter the pregnant parent's bloodstream. high levels of AFP suggest that the baby may have a neural tube defect such as spina bifida. Spina Bifida Ultrasound-An ultrasound is the most accurate way to diagnose spina bifida in your baby before delivery. It may be done at 18 to 22 weeks. Diagnosis Amniocentesis-If the prenatal ultrasound confirms the diagnosis of spina bifida, your healthcare professional may request a test called amniocentesis. Definitions cont.  Neurological assessment: Evaluate muscle strength and reflexes, and motor and sensory function below the spinal defect Skin integrity: Monitor for skin breakdown and pressure ulcers over the spinal defect Bowel and bladder function: Assess and implement a management plan for bowel and bladder function Nursing Mobility assessment: Evaluate mobility level and Assessments identify assistive devices Orthopedic assessment: Assess for orthopedic issues, such as scoliosis or joint contractures Psychosocial assessment: Evaluate the child's and family's emotional well-being Educational assessment: Assess developmental and educational needs and collaborate with educators  Treatments There is no cure for spina bifida, Surgery A neurosurgeon may Physical therapy can help with but treatments can help manage perform surgery to close the spinal strengthening and stretching and symptoms and defect, especially within the first may begin when a child is 18 complications. Treatments 48 hours of life months to 2 years old. include: Treatments for bowel and urinary Medications: Antispasmodic agents Mobility aids, such as wheelchairs problems may include diet, and anticholinergics may be used or walking aids, can help with enemas, bladder surgery, self- to prevent upper urinary tract mobility. catheterization, and continence complications. pads. Myelomeningocele requires surgery to close the opening in the Children with spina bifida may baby's back within 72 hours of Daily skin checks are important to need support with learning birth. Early surgery can help lower avoid pressure sores. disabilities and physical the risk of infection associated problems. with the exposed nerves. It also may help protect the spinal cord from more trauma.  Neonatal Abstinence Syndrome (also called NAS) is a group of conditions caused when a baby withdraws from certain drugs he’s exposed to in the womb before birth. NAS is most often caused when a woman takes drugs called opioids during pregnancy. But it can also be caused by antidepressants Neonatal (used to treat depression), barbiturates or benzodiazepines (sleeping pills). Abstinence When you take these drugs during pregnancy, they can pass through the placenta and cause Syndrome serious problems for your baby. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord.  Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted. At birth, your baby's dependence on the substance continues. However, since the drug is no longer available, your baby's central nervous system becomes overstimulated causing the symptoms of withdrawal. Some drugs are more likely to cause NAS than others, but nearly all have some effect on your baby. Opiates, such as heroin and methadone, cause withdrawal in about half of babies exposed prenatally. Medication Cocaine may cause some withdrawal, but the main symptoms in your baby are s that due to the toxic effects of the drug itself. cause NAS… Other drugs, such as amphetamines, barbiturates, and narcotics, can also cause withdrawal. Alcohol use causes withdrawal in your baby, as well as a group of problems including fetal alcohol syndrome.  Signs & Symptoms of NAS Signs of NAS depend on: What drug you used during pregnancy, how much you used and how long you took it How your own body breaks down the drug Your baby’s gestational age at birth (number of weeks of pregnancy) Finnegan NAS Score NAS babies…need soothing and lots of cuddles!!