The infant exposed to opioids in utero frequently presents a challenge to the neonatal care provider in the assessment and treatment of symptoms of Neonatal Abstinence Syndrome (NAS) after birth. This review is intended to provide the health care professional with a brief review of current evidence and practical guidelines for optimal evaluation and pharmacologic management of the opioid exposed newborn.
Methadone offers significant therapeutic benefits to the population of pregnant, opiate-dependent women and is currently the treatment of choice for this group. Yet the problem of women who elect to breastfeed while on methadone maintenance frequently vexes providers. Although breast milk offers advantages clearly beneficial to the general population of infants, there is debate about recommending breastfeeding to postpartum women receiving methadone maintenance. Although previous research has shown that amounts of methadone in breast milk appear to be very small, and therefore breastfeeding seems to be safe, women on methadone do not often breastfeed, for a variety of reasons. This article provides an overview of the issues facing providers in treating methadone-maintained women who elect to breastfeed. A comprehensive review of existing literature on the subject is offered, along with clinical advice for practitioners providing care to this population of women and children.
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