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Book 3: Maternal and Fetal Care
UNIT 11: NEONATAL ABSTINENCE SYNDROME (NEONATAL OPIOID WITHDRAWAL SYNDROME)

Select the one best answer to each question (unless otherwise instructed). Record your answers on the test.

Neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome (NAS), is a multisystem disorder caused by the abrupt discontinuation of chronic fetal exposure to substances used by the mother during pregnancy. Which of the following statements describes a sign or symptom shown to be specific for NAS/NOWS?

The risk, timing, and duration of NAS/NOWS depends on the type of substance used by the mother. Which of the following exposures is most likely to result in withdrawal signs and symptoms in the first 24 hours after birth

How long should a healthy term neonate who is at risk for NAS/NOWS be monitored in the hospital after birth?

Which of the following increases the risk and/or severity of developing NAS/NOWS in newborns exposed to in utero opioids?

A. Female sex
B. Co-exposure to benzodiazepines
C. Prematurity
D. Exposure to buprenorphine
E. Lower birth weight

While NAS is a clinical diagnosis, toxicological confirmation is necessary to be able to identify the exact type of substance used, as well as confirm and/or rule out expo sure to other licit and illicit substances. Which of the following statements regarding toxicology screening in the newborn is correct?

A. Meconium toxicology screening has a long detection window, starting from the beginning of the second trimester of pregnancy.
B. Urine toxicology screenings have a detection window of 5 to 7 days.
C. The umbilical cord is a good screening biomatrix because of the high concentra tion of drugs in the cord.
D. A negative toxicology screening result rules out NAS/NOWS.
E. Toxicology screening is helpful in providing additional information on the frequency and patterns of drug use.

The Eat, Sleep, Console (ESC) approach was developed to assist in the monitoring and management of neonates with NAS. Which of the following statements regard ing ESC is incorrect?

A. A bottle-feeding newborn able to ingest 1 ounce per feeding is considered to be feeding well.
B. A newborn able to sleep for 90 minutes undisturbed is considered to be sleeping well.
C. A newborn able to be consoled in 10 minutes or less is considered consolable .
D. The use of the ESC approach has led to a decrease in pharmacological treatment needs.
E. The use of the ESC approach has led to a decreased length of stay.

The use of the ESC approach to manage newborns with NAS/NOWS is associated with an increased risk of hospital readmission for NAS symptoms .

True
False

Nonpharmacological interventions are the preferred first-line treatment for NAS/ NOWS and should be optimized prior to considerations of pharmacological treat ment. Which of the following statements regarding nonpharmacological manage ment approaches is incorrect?

A. Admission to the neonatal intensive care unit should be avoided whenever possible.
B. Routine care should be clustered and should follow the newborn's schedule.
C. Feeding the newborn every 3 hours is recommended to assist with establishing a routine .
D. Rooming-in with the mother has been shown to be an effective way to reduce the length of hospital stay.
E. Slow and rhythmic vertical rocking may be helpful in newborns with NAS/NOWS who are difficult to console.

Breastfeeding is contraindicated in neonates with NAS/NOWS

True
False

Establishing a safe care plan for neonates with NAS/NOWS is a federal mandate .

True
False