Tenenbein et al listed clinical findings in neonates with withdrawal symptoms associated with maternal volatile substance abuse. The authors are from Children's Hospital in Winnipeg, Manitoba, Canada.
Maternal findings:
(1) maternal history of heavy volatile substance abuse
(2) smell of hydrocarbons on admission for labor and delivery
(3) negative screen for other drugs of abuse (Most abusing mothers either preferred volatile substances or did not have access to other drugs of abuse. As an aside, a positive drug screen does not mean that the drug identified is the cause of the withdrawal symptoms.)
Neonatal findings:
(1) metabolic acidosis, which was either transient or persistent (for up to 14 days)
(2) excessive and high-pitched cry
(3) sleeplessness
(4) tremors
(5) hypertonia
(6) poor feeding
Neonatal findings other than metabolic acidosis were scored using the Finnegan Neonatal Abstinence Scoring System (see above). Since other findings from the scoring system are usually absent, an abbreviated subscale is shown below:
|
Parameter |
Finding |
Points |
|
cry |
not high pitched |
0 |
|
|
high pitched, but not continuous |
2 |
|
|
continuous high pitched |
3 |
|
sleep after feeding |
3 or more hours |
0 |
|
|
2 to less than 3 hours |
1 |
|
|
1 to less than 2 hours |
2 |
|
|
< 1 hour |
3 |
|
tremor |
none |
0 |
|
|
mild, when disturbed |
1 |
|
|
marked, when disturbed |
2 |
|
|
mild, even when undisturbed |
3 |
|
|
marked, even when undisturbed |
4 |
|
|
generalized convulsions |
5 |
|
muscle tone |
not increased |
0 |
|
|
increased |
2 |
|
feeding |
fair to good |
0 |
|
|
poor |
2 |
total score =
= SUM(points for all 5 findings)
Phenobarbital was administered if either:
(1) The average score was >= 8 on 3 consecutive 2 hour intervals.
(2) The average score was >=12 on 2 consecutive 2 hour intervals.
Phenobarbital therapy reduced crying, improved feeding and improved sleeping.
Affected infants were placed in foster homes.
Specialty: Toxicology, Emergency Medicine, Critical Care
