A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic

Loudin, Sean; Werthammer, Joseph; Prunty, Leesa; Murray, Sara G.; Shapiro, Joseph I.; Davies, Todd H.

doi:10.1038/jp.2017.101

Cited by 22 publications

(12 citation statements)

References 17 publications

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“…A literature search of published research related to neonatal abstinence syndrome and polysubstance exposure was combined with clinical experience from a hospital with a dedicated NAS unit that treats 200-300 neonates annually with proven prenatal exposure and severe withdrawal symptoms to produce this manuscript. 5 The goal was to combine what was published in literature with what our hospital sees on a dayto-day basis in hopes of presenting a guide for each presentation of neonatal abstinence syndrome due to polysubstance exposure. The literature search was not limited based on date or study design.…”

Section: Scope and Purposementioning

confidence: 99%

Symptomology Associated with in Utero Exposures to Polysubstance in an Appalachian Population.

Lester¹,

Andrews²,

Nellhaus³

et al. 2019

Marshall Journal of Medicine

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Neonatal abstinence syndrome (NAS) is seen at a very high rate at our institution in Huntington, West Virginia, and the majority of exposures are polysubstance in nature. Polysubstance can have different meanings for different regions. At our institution, polysubstance is any combination of opioids, gabapentin, methamphetamine, cocaine, marijuana, benzodiazepines, nicotine or other neuroactive substances with three to four substances being the norm. Rapidly changing combinations of drug use and the lack of literature creates a difficult situation for clinicians who are often reliant on treatment recommendations that lack references or conclusive data supporting the clinical approaches. Elucidating withdrawal symptoms consistent with in utero exposures to particular drug combinations is difficult. Many substances induce similar withdrawal symptoms in neonates and the vast majority of cases present as polysubstance exposure. Standard methodology often leads to a research approach which isolates populations and substance of exposure to determine the individual effects on the neonate. In some drug combinations, like opioid and gabapentin exposure, the substances in concert create symptoms and complications that are not observed with either drug alone. The history of responses to substance use epidemics has been to handle each drug as a separate disease process; this is no longer a viable option. The following is a review of the literature available discussing individual substance withdrawal characteristics in neonates combined with the clinical insight gained at our hospital from treating such high rates of complex polysubstance exposure.

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Section: Scope and Purposementioning

confidence: 99%

Symptomology Associated with in Utero Exposures to Polysubstance in an Appalachian Population.

Lester¹,

Andrews²,

Nellhaus³

et al. 2019

Marshall Journal of Medicine

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“…Preconiza-se em muitos protocolos que os cuidados iniciais de todos os bebês que foram expostos a substâncias no útero devam ser individualizados, de suporte e não-farmacológicos 5 . Essa terapia que não envolve medicamentos utiliza-se da minimização de estímulos ambientais luminosos e sonoros e de práticas como repouso e sono adequados, alimentação hipercalórica, amamentação, massagem, musicoterapia, recrutamento de voluntários para acariciar o bebê e enrolamento dos neonatos em panos, dando-lhes a sensação de serem segurados por tempo integral 1,4,5 . Estudos têm demonstrado consistentemente que bebês que ficam no quarto com suas mães (alojamento conjunto) têm uma permanência hospitalar e duração da terapia mais curtas 5 .…”

Section: Tratamentounclassified

Síndrome De Abstinência Neonatal: Revisão Dos Aspectos Maternos E Neonatais

Li¹,

Mascari²,

Medeiros³

2018

Blucher Medical Proceedings

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Neonatal (SAN) é um conjunto de sinais e sintomas derivados da interrupção da exposição fetal às substâncias ingeridas durante a gravidez, como opioides, antidepressivos e nicotina. Nos Estados Unidos o uso de opiáceos por gestantes mais do que quadruplicou na última década e está intimamente associado com aumento nos casos de SAN. Objetivos: Apresentar os principais dados da literatura sobre prevenção, fisiopatologia, quadro clínico, tratamentos e prognóstico da SAN. Metodologia: Utilizamos os descritores "Neonatal Abstinence Syndrome/diagnosis" OR "Neonatal Abstinence Syndrome/physiopathology" entre outros, obtidos por meio da ferramenta MeSH e busca na base de dados MEDLINE. Foram identificados 30 artigos gratuitos entre 2015-2018 e selecionados 17. Resultados: O diagnóstico consiste em história pré-natal, achados clínicos e aplicação da Escala de Finnegan (EF), que investiga abuso de opioides e outras substâncias. Testes de urina maternos e investigação do mecônio, cabelo, sangue do cordão umbilical e urina do recém-nascido (RN) são utilizados. Alterações no sistema nervoso e gastrointestinal justificam a irritabilidade, convulsões, hipertonia, febre, choro anormal e vômitos. A fisiopatologia não está bem esclarecida, mas acredita

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“…Because of issues related to rurality, poverty, and incidence of licit and illicit opioid use, West Virginia (WV) has experienced sharp increases in the rates of NAS. We have reported a 9.4% incidence of NAS requiring medication treatment at our major teaching hospital [9]. NAS is characterized by symptoms affecting the central and autonomic nervous systems as well as the gastrointestinal system.…”

Section: Introductionmentioning

confidence: 99%

Necrotizing enterocolitis and its association with the neonatal abstinence syndrome

Andrews

Davies

Haas

et al. 2020

NPM

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OBJECTIVE: The purpose of this study was to describe an identified association between necrotizing enterocolitis (NEC) and prenatal opioid exposure with neonatal abstinence syndrome (NAS) in late preterm and full-term neonates. STUDY DESIGN: In this single-center retrospective cohort study, we analyzed inborn neonates with the diagnosis of NEC discharged from 2012 through 2017. We compared infants with NEC > 35 weeks' gestation to those with NEC<35 weeks' gestation. We compared gestational age, birth weight, age of onset of symptoms, and incidence of prenatal drug exposure between groups. Significance was determined using Mann-Whitney and Fisher's exact tests. RESULTS: Over the study period, 23 infants were identified with NEC, 9 (39%) were babies > 35 weeks at birth and 14 (61%) < 35 weeks. Those > 35 weeks had a higher birth weight, earlier onset of symptoms, and a higher percentage of prenatal exposure to opioids compared to those < 35 weeks' gestation. We further described seven infants with late gestational age onset NEC associated with prenatal opioid exposure. CONCLUSIONS: In this cohort of infants with NEC discharged over a 6 year period we found a higher than expected percentage of infants born at a later gestational age. We speculate that prenatal opioid exposure might be a risk factor for NEC in neonates born at > 35 weeks.

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A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic

Cited by 22 publications

References 17 publications

Symptomology Associated with in Utero Exposures to Polysubstance in an Appalachian Population.

Symptomology Associated with in Utero Exposures to Polysubstance in an Appalachian Population.

Síndrome De Abstinência Neonatal: Revisão Dos Aspectos Maternos E Neonatais

Necrotizing enterocolitis and its association with the neonatal abstinence syndrome

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