Cystic Fibrosis and Narcotic Withdrawal in the Newborn

1
Cystic Fibrosis and Narcotic Withdrawal in the
Newborn

• Jessica Brandt
• and
• Susie Clabots

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Patient Information

• Male (approx. 1 mo)
• DOB 12/20/07 (4 wks premature per cesarean
  delivery, with a birth weight of 2.14kg)
• Current weight 2.5 kg (below 5th percentile)
• VS HR 151, RR 46, SpO2 98 on RA, Temperature
  98.1 F
• Diagnosed with Cystic Fibrosis (homozygous F?508)
  and Narcotic Withdrawal (methadone)
• Neonatal bilirubin 8.9 (1-7mg/dL)
• Direct bilirubin 0.5 (0-0.5mg/dL)
• Fecal Negative for ova and parasites, rotavirus
  negative.
• Sputum culture negative for WBCs, rare squamous
  epithelial cells, P. aeruginosa, S. maltophilia,
  B. capacia, S. aureus, H. influenzae.

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Family History

• Mother, father also have a 4 year old at home and
  other siblings from previous marriages are living
  with other spouses (not much contact).
• Dad works full time, has insurance through work.
• Mom not employed. Mom has history of depression,
  illegal drug use, diabetes, and hypothyroidism.
  She was attempting methadone tx for addiction to
  opioids.
• Most recently she was obtaining methadone
  illegally, about 60mg BID for 1.5 years.
• Mom uses bus for transportation to the hospital
  and states difficulty in finding a sitter for the
  other sibling.

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More Family Issues

• Family reports a lack of knowledge regarding CF
  (possible nursing Dx Knowledge deficit r/t
  family unfamiliarity with chronic disease
  management)
• Although they initially expressed a willingness
  to learn and are scheduled for classes, they are
  repeatedly not showing up for them.
• Mothers lack of presence.
• No heat in the familys home because their power
  was shut off? (The baby is underweight and does
  not have much fatty insulation to keep warm, also
  has a large diaper rash that covers most of his
  buttocks and must be open to air (which is cold
  and uses even more of his scarce energy).
• Hospital will not discharge the baby to the
  family until standards are met.
• Possibility of patient ending up in the foster
  care system realistic?

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Narcotic Withdrawal in the Infant

• Transferred from Swedish Medical Center on 1/3/08
  for CF clinic, monitoring, and family teaching.
• Weaned using morphine starting 12/17/08
• Stable on 0.3mg PO q3h weaned by 10 dose
  (0.03mg) qd.
• By 1/2/08 at 0.15mg PO q3h.
• Breastfeeding and a maintenance dose?

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Current Health Issues

• Feeding difficulty
• Possible Nursing Dx Imbalanced nutrition less
  than body requirements r/t inability to digest
  nutrients.
• Failure to Thrive
• Intermittent use of nasogastric tube for feedings
• Diaper rash increasing in severity and has spread
  to scrotum and frequent stooling irritates the
  affected areas.
• Possible Nursing Dx Acute pain r/t excoriation
  from the diaper rash.
• Diarrhea (dehydration, electrolyte imbalance,
  susceptible to illness, excoriated buttocks are
  not healing).
• Obtaining adequate nutrients using supplements
  (fat soluble vitamins ADEK).
• Administering digestive enzymes with meals to
  promote breakdown and use of nutrients.
• Chest physiotherapy

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References

• http//www.uwcfcenter.org/acc/
• http//www.newbornmedicine.com/methadone/methadone
  Paper.htm