A fetus has been exposed in utero drug (as fetuses, are exposed to the harmful substances referred to [FENS]) may be dependent during pregnancy. The titmouse toxic substances that are taken from the mother, are generally illegal. In any case, the domestic situation should be examined to determine if the infant is to be released in caring relationships. It must be determined whether the mother with the support of relatives, friends and outpatient care service is able to care for their child. If this is not the case, if necessary, accommodation with foster parents or otherwise preferable.
Alcohol and illicit drugs are toxic to the placenta, and for the developing fetus and can on the one hand on the other hand lead to congenital syndromes and withdrawal symptoms. Prescription drugs also have negative effects on the fetus can (see table: Some drugs with adverse effects during pregnancy). Fetal alcohol syndrome and the effects of cigarette smoking on the fetus are discussed elsewhere. A fetus has been exposed in utero drug (as fetuses, are exposed to the harmful substances referred to [FENS]) may be dependent during pregnancy. The titmouse toxic substances that are taken from the mother, are generally illegal. In any case, the domestic situation should be examined to determine if the infant is to be released in caring relationships. It must be determined whether the mother with the support of relatives, friends and outpatient care service is able to care for their child. If this is not the case, if necessary, accommodation with foster parents or otherwise preferable. Amphetamines Prenatal exposure to Amphetaminenhat long-term subtle effects on the Hirnstruktur- and function of newborns. Some studies have shown a reduced volume of the caudate nucleus, putamen and globus pallidus (anatomical components of the brain) in methamphetamine-exposed children, while other studies do not confirm these findings uniform. Other studies show that prenatal exposure can drag abnormal neurological patterns or fetal growth disorders after with methamphetamines, but these results have not been fully secured. Barbiturates A prolonged maternal Barbituratmissbrauch can lead to neonatal drug withdrawal syndrome associated with tremors, irritability and behavioral problems; The symptoms often occur only 7-10 days after birth, and thus usually after discharge home. Sedation with phenobarbital at a dose 0.75-1.5 mg / kg p.o. or i.m. 4 times a day may be necessary and then you have a few days or weeks, depending on the duration of symptoms, be tapered. Cocaine Cocaine inhibits the reuptake of the neurotransmitters norepinephrine and epinephrine; It crosses the placenta and causes the fetus vasoconstriction and hypertension. The placenta solution for intrauterine death or if the child survives, lead to neurological damage. Of cocaine abuse during pregnancy is associated with an increased incidence of premature detachment of the placenta and spontaneous abortions, possibly caused by reduced blood flow to the maternal placental vascular bed. Newborns addicted mothers have a low birth weight, decreased body length and head circumference and lower Apgar numbers. There may be cerebral infarction, also occur in rare cases in connection with prenatal cocaine abuse limb amputations, gastrointestinal malformations such as prune belly defect (Bauchdeckenaplasie) and a Darmatresie or necrosis on. All malformations caused by vascular damage, probably secondary to cocaine-induced vasoconstriction severe fetal arteries that then lead to local ischemia. In addition, a pattern of abnormal behavior was observed such. B. attention and Wachsamkeitsdefizite, lower IQ, and deficits in fine and gross motor skills. Some newborns experience withdrawal symptoms if the mother has taken her to give birth cocaine, but the symptoms are less frequent and less pronounced as the opioid withdrawal; the findings and the treatments are the same. Marijuana marijuana apparently not consistent increases the risk of congenital malformations, fetal growth restriction, or a neurological behavioral problems. However, women use marijuana during pregnancy, use of alcohol, cigarettes, or both, can cause fetal problems. Opiates Contact with opiates in utero may result in a withdrawal syndrome after birth. The newborn of a woman who has chronically used opioids during pregnancy should, on withdrawal symptoms (narcotic abstinence syndrome [NAS]) are observed. NAS is usually done within 72 hours after birth, although many neonatal units infants observed for 4 or 5 days to make sure that there are no significant signs of a withdrawal. Characteristic signs of withdrawal include irritability eccentricity hypertension, vomiting and / or diarrhea sweating seizures hyperventilation that causes respiratory alkalosis. Similar effects can be caused by prenatal contact with benzodiazepines. There are many scoring systems to quantify the severity of withdrawal (The opioid Exposed Newborn: Assessment and Pharmacologic Management). Mild withdrawal symptoms can be treated by frequent winding and intensive care to reduce hyperexcitability and frequent feeding to reduce anxiety. With appropriate patience, some problems within a week to resolve. However, up to 80% of children need to NAS drug treatment, usually an opioid, sometimes with the addition of clonidine. Phenobarbital (0.75-1.5 mg / kg po every 6 h) can help, but is now considered as a treatment 2nd choice. The treatment is tapered off after a few days or weeks, depending on the resolution of symptoms, many children need up to 5 weeks of continuous therapy. There is no consensus on dias best medication, but most experts use methadone, morphine, or sometimes tincture of opium dose based on the weight of the infant and the severity of symptoms. Typically, an initial dose is given and increased until symptoms are controlled and then slowly tapered off (see Table: A drug treatment for opioid withdrawal in). Drug treatment for opioid withdrawal in drug dose incremental increase cone morphine 0.04 mg p.o. every 3-4 h 0,04 mg / kg / dose every 2-3 days methadone 10-20% 0.05-0.1 mg / kg every 6 h 0.05 mg / kg / dose 10 -% q wk adapted from Hudak ML, Tan RC, the Committee on drugs, the Committee on fetus and newborn: newborn drug withdrawal. Pediatrics129: E540-E560, 2012. The addition of clonidine 1 mcg / kg p.o. every 4 h can reduce the duration of drug treatment, which is required in full-term newborn infants. However, clonidine should not be given premature infants because of the risk of bradycardia is. If clonidine is used, the blood pressure should be monitored when the dose is tapered clonidine because a rebound -Hypertonie may be. The incidence of SIDS is higher in children of opiate-dependent mothers, but still <10/1000 children; the routine use of a home monitor to monitor heart and respiratory rates is not recommended for these children. More information The opioid Exposed Newborn: Assessment and Pharmacologic Management