7d0b68e84849bad89e2d486786396188.ppt
- Количество слайдов: 51
ﻣﺮﺩﻡ ﺩﻭ ﺩﺳﺘﻪ ﺍﻧﺪ: ﺩﺳﺘﻪ ﺍﻱ ﺑﺮﺍﺩﺭ ﺩﻳﻨﻲ ﺗﻮ ﻭ ﺩﺳﺘﻪ ﺩﻳگﺮ ﻫﻤﺎﻧﻨﺪ ﺗﻮ ﺩﺭ آﻔﺮﻳﻨﺶ. ﺍگﺮ گﻨﺎﻫﻲ ﺍﺯ آﻨﺎﻥ ﺳﺮ ﻣﻲ ﺯﻧﺪ ﻳﺎ ﻋﻠﺖ ﻫﺎﻳﻲ ﺑﺮ آﻨﺎﻥ ﻋﺎﺭﺽ ﻣﻲ ﺷﻮﺩ، ﻳﺎ ﺧﻮﺍﺳﺘﻪ ﻭ ﻧﺎﺧﻮﺍﺳﺘﻪ ﺍﺷﺘﺒﺎﻫﻲ ﻣﺮﺗﻜﺐ ﻣﻲ گﺮﺩﻧﺪ آﻨﺎﻥ ﺭﺍ ﺑﺒﺨﺸﺎﻱ ﻭ ﺑﺮ آﻨﺎﻥ آﺴﺎﻥ گﻴﺮ. آﻦ گﻮﻧﻪ ﻛﻪ ﺩﻭﺳﺖ ﺩﺍﺭﻱ ﺧﺪﺍ ﺗﻮ ﺭﺍ ﺑﺒﺨﺸﺎﻳﺪ ﻭ ﺑﺮ ﺗﻮ آﺴﺎﻥ گﻴﺮﺩ. ﺍﻣﺎﻡ ﻋﻠی)ﻉ(
Maternal & Newborn Effects of Prenatal Substance Abuse Noori-Shadkam M(MD)
Objectives Substance use and pregnancy ¡ Maternal & fetal effects during pregnancy ¡ Withdrawal syndrome ¡ treatment ¡
Behavior during pregnancy ¡ Behaviors of drug-using pregnant women contribute to H. R pregnancy l l l Unsafe sex with risk of violence Infection from injection Stimulant abuse may lead to early labor Poor nutrition Lack of prenatal care
Drug Classes ¡ Alcohol ¡ Opioids ¡ Stimulants ¡ Nicotine ¡ Marijuana
Opioids ¡ ¡ Morphine heroin Oxy. Contin methadone
Effects on mothers • Extrauterine pregnancies • Premature labor • PROM • Uterin irritability • Breech presentation • Antepartum hemorrhage • Toxemia
Con… • Anemia • Infections • Stillbirth
Opioids: Effects on fetus ¡ ¡ ¡ Hyperactivity Hypoxia Meconium passage No known fetal anomalies Utero demise
Effect on neonate • LBW • Thrombocytosis & increased circulating platelet aggregation • Abnormal thyroid function • Decrease HMD • Decrease sever hyperbilirubinemia
Neonatal withdrawal syn.
Follow-up reports • Neurobehavioral deficits • Decrease visual & auditory orientation • Decrease motor maturity • More jerkiness • Tremulousness • Hypertonicity
Con… • Irritability • Increase cry • Decrease PDI • Increase nystagmus; strabismus & otitis media
Stimulants o o o Cocaine Crack Amphetamine Methamphetamine MDMA(Ecstasy) Caffeine
Cocaine
Pharmacologic effects Norepinephrine effect tachycardia arrhythmias hypertension vasoconstriction diaphoresis mild tremors
Pharmacologic effects Dopamin effects increased alertness enhanced sense of well-being & self-stem heightened energy sexual excitement
Effects on mother • Spontaneous abortion • Abruptio placenta • PROM • STD
Effects on fetus & neonate ¡ ¡ ¡ Fetal hypoxia Fetal hypertention Cocaine-Induced ischemia intestinal atresia infarction NEC
Con… • G. U malformation • STD • Prematurity • IUGR • SIDS • Diminished alertness • Poorer state regulation
Con… • Abnormal reflex; tone & motor maturity • Impaired autonomic control • Irritability • Poorer orientation • Decreased habituation
Amphetamine
Effects on mother • Miscarriage • Placental hemorrhage
Effects on fetus • Prematurity • IUGR • Congenital anomaly cardiovascular musculoskeletal
Complication • Cardiac arrhythmia • ARF • DIC • Rhabdomyolysis • Learning & memory damage
Con… • Loss of sexual pleasure • Effect on cognitive; sleep; appetite • death
Nicotine ¡ ¡ Cigarettes pipe
Nicotine release • Acetylcholine • Norepinephrine • GABA • Glutamine • Dopamine
Nicotine • Increase HR • Increase BP • Increase RR • Hyperglycemia • Decrease appetite
Nicotine: Withdrawal symptom • Irritability • Headache • Nausea • Craving
Smoking: Effects on fetus ¡ ¡ Prematurity IUGR SIDS Increased risk for oral cleft
Neurobehavioral & Developmental Effects In Infancy • Increase tremulousness • Increase autonomic excitability • Increase ADHD • Decrease auditory habituation • Decrease auditory responsiveness • Decrease verbal comprehension • Decrease verbal learning & memory
Marijuana & Hashish
Acute Effect • Euphoria & Relaxation • Increase HR • Increase BP in a seated or supine • Decrease BP in a standing • Dizziness • Decrease salivation • Increase appetit
Con… • Impaired coordination • Poor decision making • Delayed responding • Altered sense of time • Impaired concentration & learning
Effects on fetus & neonate ¡ o o Brain abnormalities (in animal model) LBW(? ) Meconium passage
treatment ¡ Pregnancy ¡ Neonate
Treatment in pregnancy ¡ Reduce disease & crime Counseling Social service ¡ Avoid withdrawal & craving Maintenance vs. detoxification Long-acting medication for control o STD
Methadone Long-acting pure opioid agonist ¡ Available for opioid addiction treatment ¡ Requires daily clinic visits, but may get take-home dose privileges ¡ Also used for pain like other Schedule II opioids ¡
Methadone and Pregnancy ¡ ¡ Standard of care for opioiddependent pregnant women Stabilization of mother and fetus l l ¡ ¡ Medical and social Higher dose in 3 rd trimester Improves growth of fetus & newborn Decreases practice of high-risk behaviors
Buprenorphine ¡ ¡ ¡ Long-acting opioid agonist-antagonist Office-based opioid addiction treatment l Schedule III l Buy at local pharmacy (Subutex, Suboxone) Very low risk of overdose Combined with naloxone Used for acute pain treatment (Buprenex)
Buprenorphine and Pregnancy ¡ ¡ Pregnancy Category C Use Subutex instead of Suboxone to avoid naloxone NAS less intense than with methadone Studies ongoing, results encouraging
Treatment in neonate
The goal is an infant who • • • No irritable No vomitting No diarrhea Can feed well Sleep between feeding
Symptomatic treatment • Tight swaddling • Holding • Rocking • Placing in a slightly darkened quiet area • Hypercaloric formula • Never give naloxone
Medication • Neonatal morphine solution(NMS) • Phenobarbital • NMS+Pb
NMS score 8 -10 11 -13 14 -16 17 or >17 NMS 0. 8 ml/kg/day 1. 2 1. 6 2
Phenobarbital Loading 20 mg/kg 30 40 Maintenance 5 mg/kg/d 6. 5 8
NMS & pb NMS 0. 4 ml/kg/day Pb loading dose 10 mg/kg then 5 mg/kg/day
7d0b68e84849bad89e2d486786396188.ppt