Deutsch Website, wo Sie Qualität und günstige https://medikamenterezeptfrei2014.com/ Viagra Lieferung weltweit erwerben.

Zufrieden mit dem Medikament, hat mich die positive Meinung propecia kaufen Viagra empfahl mir der Arzt. Nahm eine Tablette etwa eine Stunde vor der Intimität, im Laufe der Woche.

Untitled

N E O N A T A L A B S T I N E N C E S Y N D R O M E Handling drug misuse in the
neonatal unit

Neonatal abstinence syndrome (NAS), a syndrome of newborn drug withdrawal, is increasing inincidence across the developed world. To optimally manage the infant with NAS an integratedmultidisciplinary approach is necessary, spanning the intrauterine and postnatal period. Such anapproach should incorporate screening for drugs of misuse, early involvement of communityservices, standardised scoring of NAS symptoms in the drug exposed infant, and the appropriatecommencement and monitoring of evidence-based pharmaceutical therapy.
Lesley Jackson
MD, MBChB, FRCPCH
Neonatal Abstinence Syndrome (NAS) City of Glasgow has a well-established,
integrated, multidisciplinary service for the uterine exposure to a variety of different consequences for the offspring. Short term chemical substances. These include the well caffeine and antidepressants1 (particularly The clinical presentation of NAS is varied selective serotonin reuptake inhibitors) can and affected infants exhibit non-specific features include irritability, jitters, poor persistent high-pitched crying. Seizures can Keywords
infants has been reported to vary between Key points
urban and socially deprived areas reporting Jackson, L. (2006) Handling drug misuse in
the neonatal unit. Infant 2(2): 64-67.
Scottish statistics on drug misuse reported 2. Scoring charts can be used to identify explore the methods used to identify cases the evidence underlying appropriate treat- 3. Since opiates are excreted in breast milk risen 10-fold over the last decade, such that Care Baby Unit (SCBU) are transferred for term consequences for these infants.
Screening for drugs of misuse in
clinical burden has clear implications for pregnancy
NAS, awareness of the local pattern of drug V O L U M E 2 I S S U E 2 2 0 0 6 infant
N E O N A T A L A B S T I N E N C E S Y N D R O M E meconium and thereafter can be detected.
This includes illicit drugs excreted by the scoring should occur relative to feeds (i.e. a extent of misuse during pregnancy and the liver into the biliary system and substances specific substances misused. These include recently fed baby). Scoring charts are not clinical use were developed for use within opiate withdrawal. Increasingly such charts clinical scenarios i.e. premature infants, infants exposed to other illicit substances 16 weeks’ gestation until term, giving a substances can be analysed in detail. The sensitivity and positive predictive value of Treatment of NAS
In-patient management
Despite the increasing clinical burden of antenatal clinics reported that 11-16% had NAS, clinical trial evidence is insufficient used at least one illicit substance by the also been examined for drug metabolites.
time of booking: cannabis misuse being the In the adult, hair grows at a rate of 10mm condition. In Glasgow, infants treated for deposited in the growing hair shaft, giving a wide time potential analytical window for additional morbidity, such as prematurity, history relative to biochemical screening the detection of substance misuse15. In the methodologies, identified that the actual incidence of drug misuse during pregnancy third trimester, but can often be sparse, which may limit analytical potential. Hair analysis in the newborn remains relatively infant, and often the mother, remains the an infant exposed to cocaine in utero. mother-infant bonding18,19. Breastfeeding extensively utilised, and relies on the ability metabolites of illicit substances in the urine to concentrations many times greater than Scoring charts
that detected through analysis of plasma.
assessing the infant with NAS, clinicians potential disadvantages10. Urinary screening management decisions. Scoring the clinical is necessary (FIGURE 1).
substance exposure pre-delivery, resulting have been used as treatments for NAS.
subdivided into two major classes: disease borns may pass little urine in the first 48 hours of life and urine collection bags, to treatment initiated. All scoring charts are facilitate sample collection, can produce observer variability and a recent national central nervous system suppressants which survey in the United States reported that first stool passed by a newborn infant, is clonidine, chloral hydrate, chlorpromazine, presently the ‘gold standard’ methodology used such a scoring chart16. A variety of opioids, opiates and phenobarbitone20.
scoring charts exist, from the simple to the treat NAS can be criticised for their lack of tool is a relatively simple validated method usefulness of meconium analysis11-13.
Theoretically, all substances that reach the to utilise validated scoring systems to allow infant VO L U M E 2 I S S U E 2 2 0 0 6
N E O N A T A L A B S T I N E N C E S Y N D R O M E Service, or can be replicated in the UnitedKingdom, remains to be determined.
Long term consequences of NAS
Few studies have followed drug-exposedchildren beyond the first few years of life,and confounding variables, such asenvironment and dysfunctional caregiversmake it extremely difficult to attribute anydifferences observed in ability to NAS perse. Detailed long term evaluation ofchildren exposed to drugs in utero isnecessary to determine whether cognitiveability, social interactions and schoolachievement are detrimentally affected,and to also determine whether specifictreatments for NAS have beneficial effects.
In addition, long term follow-up ofsubsequent growth and development,extending into health in adult life isdesperately needed. Of the few published FIGURE 1 A six week old baby with neonatal abstinence syndrome treated with Oramorph.
reports available Ornoy et al haveattempted to dissect whether differences in pharmaceutical therapy20-24. In addition, little published evidence exists on the long is important from an early stage to address ‘nature’ or ‘nurture’29. Children living term effects of any of these pharmaceutical child protection issues. Child protection NAS have been covered in detail in a recent edition of Infant and will not be further arithmetic skills and an increased incidence explored in this article30. All infants that could be discharged to a potentially ‘high against hepatitis B prior to discharge, with may have a role as a second-line treatment arrangements and referral pathways should Conclusion
single small study infers that combination PCR + for hepatitis C virus as well as other therapy to treat symptomatic cases of NAS.
considered domiciliary treatment of NAS.
and application of its observations to the therapy remains the first-line treatment, management of NAS would be premature.
criteria and a multidisciplinary approach.
decisions. A multidisciplinary approach is ceutical treatments for NAS at a high initial dose, thereafter titrating downwards once thought needs to be given to the possibility general practioners and health visitors is follow-up studies are required to further domiciliary NAS service observed a reduced guide the management of this increasingly duration of hospital stay with a conversely Preparation for hospital discharge
References
1. Stiskal J.A., Kulin N., Koren G., Ho T., Ito S. Neonatal
adherence with outpatient appointments, is paroxetine withdrawal syndrome. Arch Dis Child subsequently develops symptomatic NAS.
either cost-effective for the National Health Fetal Neonatal Ed 2001;84:F134-F135.
V O L U M E 2 I S S U E 2 2 0 0 6 infant
N E O N A T A L A B S T I N E N C E S Y N D R O M E 2. Ornoy A., Segal J., Bar-Hamburger R., Greenbaum C.
11. Ostrea E.M., Jr., Matias O., Keane C. et al. Spectrum
Developmental outcome of school-age children of gestational exposure to illicit drugs and other 21. Finnegan L.P., Connaughton J.F., Jr., Kron R.E., Emich
xenobiotic agents in newborn infants by meconium J.P. Neonatal abstinence syndrome: assessment and
importance of environmental factors. Dev Med Child analysis. J Pediatr 1998;133:513-15.
management. Addict Dis 1975;2:141-58.
12. Ostrea E.M., Jr., Brady M., Gause S., Raymundo A.L.,
22. Hoder E.L., Leckman J.F., Poulsen J. et al. Clonidine
3. American Academy of Pediatrics Committee on
Stevens M. Drug screening of newborns by
treatment of neonatal narcotic abstinence Substance Abuse. Drug-exposed infants. Pediatrics
meconium analysis: A large-scale, prospective, syndrome. Psychiatry Res 1984;13:243-51.
epidemiologic study. Pediatrics 1992;89:107-13.
23. Osborn D.A., Jeffery H.E., Cole M.J. Sedatives for
4. Morrison C.L.,.Siney C. A survey of the management
13. Ostrea E.M., Jr., Brady M.J., Parks P.M., Asensio D.C.,
opiate withdrawal in newborn infants. Cochrane of neonatal opiate withdrawal in England and Naluz A. Drug screening of meconium in infants of
Database Syst Rev 2002;CD002053.
Wales. Eur J Pediatr 1996;155:323-26.
drug-dependent mothers: An alternative to urine 24. Osborn D.A., Cole M.J., Jeffery H.E. Opiate treatment
5. Jackson L., Ting A., McKay S., Galea P., Skeoch C. A.
testing. J Pediatr 1989;115:474-77.
for opiate withdrawal in newborn infants. Cochrane randomised controlled trial of morphine versus 14. Ostrea E.M., Jr. Testing for exposure to illicit drugs
Database Syst Rev 2002;CD002059.
phenobarbitone for neonatal abstinence syndrome.
and other agents in the neonate: A review of 25. Osborn D.A., Jeffery H.E., Cole M. Opiate treatment
Arch Dis Child Fetal Neonatal Ed 2004;89:F300-F304.
laboratory methods and the role of meconium for opiate withdrawal in newborn infants. Cochrane 6. Alroomi L.G., Davidson J., Evans T.J., Galea P., Howat
analysis. Curr Probl Pediatr 1999;29:37-56.
Database Syst Rev 2005;CD002059.
R. Maternal narcotic abuse and the newborn. Arch
15. Vinner E., Vignau J., Thibault D. et al. Neonatal hair
26. Osborn D.A., Jeffery H.E., Cole M.J. Sedatives for
analysis contribution to establishing a gestational opiate withdrawal in newborn infants. Cochrane 7. Johnson K., Gerada C., Greenough A. Treatment of
drug exposure profile and predicting a withdrawal Database Syst Rev 2005;CD002053.
neonatal abstinence syndrome. Arch Dis Child Fetal syndrome. Ther Drug Monit 2003;25:421-32.
27. Coyle M.G., Ferguson A., Lagasse L., Oh W., Lester B.
16. Sarkar S., Donn S.M. Management of neonatal
Diluted tincture of opium (DTO) and phenobarbital 8. Lester B.M., ElSohly M., Wright L.L. et al. The
abstinence syndrome in neonatal intensive care versus DTO alone for neonatal opiate withdrawal in maternal lifestyle study: Drug use by meconium units: A national survey. J Perinatol 2006;26:15-17.
term infants. J Pediatr 2002;140:561-64.
toxicology and maternal self-report. Pediatrics 17. Lipsitz P.J. A proposed narcotic withdrawal score for
28. Oei J., Feller J.M., Lui K. Coordinated outpatient care
use with newborn infants. A pragmatic evaluation of the narcotic-dependent infant. J Paediatr Child 9. Ostrea E.M., Jr., Knapp D.K., Tannenbaum L. et al.
of its efficacy. Clin Pediatr (Phila) 1975;14:592-94.
Estimates of illicit drug use during pregnancy by 18. Malpas T.J., Darlow B.A. Neonatal abstinence
29. Ornoy A., Michailevskaya V., Lukashov I., Bar-
maternal interview, hair analysis, and meconium Hamburger R., Harel S. The developmental outcome
analysis. J Pediatr 2001;138:344-48.
breastfeeding. N Z Med J 1999;112:12-13.
of children born to heroin-dependent mothers, 10. Wingert W.E., Feldman M.S., Kim M.H., Noble L.,
19. McCarthy J.J., Posey B.L. Methadone levels in
raised at home or adopted. Child Abuse Negl Hand I., Yoon J.J. A comparison of meconium,
human milk. J Hum Lact 2000;16:115-20.
maternal urine and neonatal urine for detection of 20. Pacifico P., Nardelli E., Pantarotto M.F. Neonatal
30. Potts, N.C. Problem drug use and child protection:
maternal drug use during pregnancy. J Forensic Sci heroin withdrawal syndrome; Evaluation of Interagency working and policies in Scotland. Infant different pharmacological treatments. Pharmacol Feeding and nutrition in the preterm
infant

Infant readers can
receive a 20% discount
off Feeding and nutrition in
the preterm infant by accessing
www.infantgrapevine.co.uk and
clicking on the link on the home page.
‘A practical yet comprehensive guide to breastfeeding are described. Case studies nutrition to the preterm infant’ – this book does exactly what it says on the back cover – ‘ensuring that safe and effective feeding skills are achieved’. Elizabeth Jones and completes the book. Each chapter contains Infant’ fills a gap in the literature by allowing for easy digestion of the facts! used to good effect within the text.
in attaining feeding independence. It is a preterm infant feeding and nutrition. The This book is relevant for all staff working neonatal unit or following discharge from hospital. The authors include a speech and manager. The editors, a breastfeeding co- Anne Tompkins
ordinator and a paediatric dietician, are Senior Staff Nurse
milk banking. Enteral feeding, growth and Neonatal Unit
North Devon District Hospital
infant VO L U M E 2 I S S U E 2 2 0 0 6

Source: http://www.infantgrapevine.co.uk/pdf/inf_008_hdm.pdf

amedes.at

Sprechen Sie uns an – wir beraten Sie gerne. Vorhandenes Übergewicht sol te abgebaut werden – dabei hilft vor al em eine vernünftige Ernährung und regelmä­Den für mich bestimmten Informationsteil habe ich erhalten ßige körperliche Aktivität (Ausdauersport). Der Insulinsensi­und gelesen. Im Aufklärungsgespräch mit meinem Arzt/tizer Metformin führt zu einer Verbesserung der In

Microsoft word - kansas history 7 planner with benchmarks.doc

KANSAS HISTORY PLANNER Objective QTR. QTR. QTR. Standard 4: Kansas, United States and World History Benchmark 1: Settlement in Kansas before 1854 1. (A) compares and contrasts nomadic and sedentary tribes in Kansas (e.g., food, housing, art, customs). 2. (A) describes the social and economic impact of Spanish, French and American explorers and traders on the Indian tribes in K

Copyright © 2010-2014 Health Drug Pdf