1. Syndrome Cats
2. Cracker Syndrome
3. Cracker Nut Syndrome
4. Crack Tooth Syndrome
5. Iliotibial Band Syndrome Crack Sound

Neonatal abstinence syndrome (NAS) is a group of problems that occurs in a newborn who was exposed to opioid drugs for a length of time while in the mother's womb.

NAS may occur when a pregnant woman takes drugs such as heroin, codeine, oxycodone (Oxycontin), methadone, or buprenorphine.

Syndrome Cats

Cracked tooth syndrome is difficult to diagnose because the fracture is usually too small to be detected with an X-ray. Gross will inspect your teeth for cracks and ask you to bite on a plastic tool that covers one tooth at a time to determine which tooth is experiencing pain. Sjogren's (SHOW-grins) syndrome is a disorder of your immune system identified by its two most common symptoms — dry eyes and a dry mouth. The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus.

These and other substances pass through the placenta that connects the baby to its mother in the womb. The baby becomes dependent on the drug along with the mother.

If the mother continues to use the drugs within the week or so before delivery, the baby will be dependent on the drug at birth. Because the baby is no longer getting the drug after birth, withdrawal symptoms may occur as the drug is slowly cleared from the baby's system.

Cotard's Syndrome; Cotton fever; Cowden syndrome; Cracked tooth syndrome; Cramp fasciculation syndrome; Crandall syndrome; Craniosynostosis–anal anomalies–porokeratosis syndrome; Cranio-lenticulo-sutural dysplasia; CREST syndrome; Cri du chat; Crigler–Najjar syndrome; Crome syndrome; Cronkhite–Canada syndrome; Cross syndrome; Crouzon. Crack cocaine, or so-called rock or rock cocaine, is cocaine in solid form. About 25 million people in the United States use cocaine at least once during their lifetime. Symptoms of cocaine intoxication include intense euphoria and pleasure followed by the person becoming hyperactive and hyperalert. When the cracked tooth syndrome diagnosis is confi rmed, an initial occlusal adjustment should be made to remove occlusal interferences and relieve symptoms (7), and then a restoration should be.

Withdrawal symptoms also may occur in babies exposed to alcohol, benzodiazepines, barbiturates, and certain antidepressants (SSRIs) while in the womb.

Babies of mothers who use opioids and other addictive drugs (nicotine, amphetamines, cocaine, marijuana, alcohol) may have long-term problems. While there is no clear evidence of a NAS for other drugs, they may contribute to the severity of a baby's NAS symptoms.

The symptoms of NAS depend on:

• The type of drug the mother used
• How the body breaks down and clears the drug (influenced by genetic factors)
• How much of the drug she was taking
• How long she used the drug
• Whether the baby was born full-term or early (premature)

Symptoms often begin within 1 to 3 days after birth, but may take up to a week to appear. Because of this, the baby will most often need to stay in the hospital for observation and monitoring for up to a week.

Symptoms may include:

• Blotchy skin coloring (mottling)
• Diarrhea
• Excessive crying or high-pitched crying
• Excessive sucking
• Fever
• Hyperactive reflexes
• Increased muscle tone
• Irritability
• Poor feeding
• Rapid breathing
• Seizures
• Sleep problems
• Slow weight gain
• Stuffy nose, sneezing
• Sweating
• Trembling (tremors)
• Vomiting

Many other conditions can produce the same symptoms as NAS. To help make a diagnosis, the health care provider will ask questions about the mother's drug use. The mother may be asked about which drugs she took during pregnancy, and when she last took them. The mother's urine may be screened for drugs as well.

Tests that may be done to help diagnose withdrawal in a newborn include:

Cracker Syndrome

• NAS scoring system, which assigns points based on each symptom and its severity. The infant's score can help determine treatment.
• ESC (eat, sleep, console) evaluation
• Drug screen of urine and of first bowel movements (meconium). A small piece of the umbilical cord may also be used for drug screening.

Treatment depends on:

• The drug involved
• The infant's overall health and abstinence scores
• Whether the baby was born full-term or premature

The health care team will watch the newborn carefully for up to a week (or more depending on how the baby is doing) after birth for signs of withdrawal, feeding problems, and weight gain. Babies who vomit or who are very dehydrated may need to get fluids through a vein (IV).

Infants with NAS are often fussy and hard to calm. Tips to calm them include measures often referred to as 'TLC' (tender loving care):

• Gently rocking the child
• Reducing noise and lights
• Skin to skin care with mom, or swaddling the baby in a blanket
• Breastfeeding (if the mother is in a methadone or buprenorphine treatment program without other illicit drug use)

Some babies with severe symptoms need medicines such as methadone or morphine to treat withdrawal symptoms and help them be able to eat, sleep and relax. These babies may need to stay in the hospital for weeks or months after birth. The goal of treatment is to prescribe the infant a drug similar to the one the mother used during pregnancy and slowly decrease the dose over time. This helps wean the baby off the drug and relieves some withdrawal symptoms.

If the symptoms are severe, such as if other drugs were used, a second medicine such as phenobarbital or clonidine may be added.

Babies with this condition often have severe diaper rash or other areas of skin breakdown. This requires treatment with special ointment or cream.

Babies may also have problems with feeding or slow growth. These babies may require:

• Higher-calorie feedings that provide greater nutrition
• Smaller feedings given more often

Cracker Nut Syndrome

Treatment helps relieve symptoms of withdrawal. Even after treatment for NAS is over and babies leave the hospital, they may need extra 'TLC' for weeks or months.

Drug and alcohol use during pregnancy can lead to many health problems in the baby besides NAS. These may include:

• Birth defects
• Low birth weight
• Premature birth
• Small head circumference
• Sudden infant death syndrome (SIDS)
• Problems with development and behavior

NAS treatment can last from 1 week to 6 months.

Make sure your provider knows about all the medicines and drugs you take during pregnancy.

Call your provider if your baby has symptoms of NAS.

Discuss all medicines, drugs, alcohol and tobacco use with your provider.

Ask your provider for help as soon as possible if you are:

• Using drugs non-medically
• Using drugs not prescribed to you
• Using alcohol or tobacco

If you are already pregnant and take medicines or drugs not prescribed to you, talk to your provider about the best way to keep you and the baby safe. Some medicines should not be stopped without medical supervision, or complications may develop. Your provider will know how best to manage the risks.

Balest AL, Riley MM, Bogen DL. Neonatology. In: Zitelli BJ, McIntire SC, Nowalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 2.

Hudak ML. Infants of substance-using mothers. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2020:chap 46.

Crack Tooth Syndrome

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Abstinence syndromes. In Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM,.eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 126.

Updated by: Kimberly G. Lee, MD, MSc, IBCLC, Clinical Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

With the arrival of the relatively inexpensive and smokable crack form of cocaine, the rate of newborns exposed to cocaine in utero rose dramatically in the early 1990s. In the mid-1990s it was estimated that 1.1% of pregnant women used crack cocaine. Early reports of neonatal behavioral abnormalities led to the label “crack baby syndrome” and were followed up with several large, longitudinal studies. Crack cocaine–exposed neonates were demonstrated to be more jittery and less likely to modify their attentional behavior based on their arousal state. During the first year, infants exposed prenatally to crack cocaine are rated as having more attentional abnormalities and being less successful at remembering stimuli in their environments. However, the term crack baby syndrome is now generally recognized as inappropriate beyond the early neonatal period, after which time the behavioral differences are more subtle and do not constitute a distinct syndrome.

Iliotibial Band Syndrome Crack Sound

Several large-scale studies were funded to follow crack cocaine–exposed babies over time. They found that the mothers who had used crack cocaine during pregnancy were different from pregnant women recruited from similar economic and ethnic/racial groups. The mothers of the cocaine-exposed infants were (1) more likely to have used alcohol, cigarettes, and marijuana during pregnancy; (2) were more likely to continue to use alcohol and drugs of abuse postnatally; and (3) were more likely to have symptoms of psychiatric distress prenatally/postnatally. These polysubstance use and psychological characteristics of crack cocaine–using women have been repeatedly documented and found to have their own negative effects on child development.

One question addressed by these studies is to what degree are any persistent difficulties seen due to the cocaine exposure itself, not the other risk factors. In regards to overall mental functioning in early childhood, some studies found small effects of the cocaine specifically and others found no effect. However, specific effects of cocaine exposure on global functioning reported in infancy were no longer detectable, or subtle, by school age.

However, several studies have shown that cocaine exposure is associated with disruptions in attention and inhibition that could not be attributed to differences in maternal functioning and exposure to other substances. These independent relations of cocaine exposure on attention and inhibition have been confirmed in animals and persist into school age. In particular, the difficulties seem to be in paying attention to the information that is important in the moment and using that information to reach goals, as opposed to acting impulsively. Unfortunately, the attentional and planning abilities that are particularly sensitive to crack cocaine are also vulnerable to alcohol, cigarette, and marijuana use during pregnancy. So although the specific effect of the cocaine may be small, crack cocaine–exposed children usually are exposed to multiple substances that all impact on the same system.

Although it may not ameliorate the effects of cocaine on attention, positive environments have been shown to reduce the rate of mental retardation and increase verbal IQ in cocaine-exposed children. The hopeful findings of researchers is that providing a home life supportive of mental development makes a substantial impact on how crack cocaine–exposed children are doing as they enter school age.

References:

1. Bendersky, , Gambini, G., Lastella, A., Bennet, D. S., & Lewis, M. (2003). Inhibitory motor control at five years as a function of prenatal cocaine exposure. Journal of Developmental Behavioral Pediatrics, 24, 345–351.
2. Harvey, A., & Kosofsky, J. A. (Eds.). (1998). Cocaine: Effects of the developing brain. Annals of the New York Academy of Sciences, 846.
3. National Clearinghouse for Drug and Alcohol Abuse Information, http://www.health.org
4. National Institute of Drug Abuse of the National Institute of Health, http://www.drugabgov
5. Singer, T., Minnes, S., Short, E., Arendt, R., Farkas, K., Lewis, B., et al. (2004). Cognitive outcomes of preschool children with prenatal cocaine exposure. Journal of the American Medical Association, 291, 2448–2456.