Child Neuroanatomical, Neurocognitive, and Visual Acuity Outcomes With Maternal Opioid and Polysubstance Detoxification

Walhovd, Kristine B.; Bjørnebekk, Astrid; Haabrekke, Kristin; Siqveland, Torill S.; Slinning, Kari; Nygaard, Egil; Fjell, Anders M.; Due‐Tønnessen, Paulina; Bjørnerud, Atle; Moe, Vibeke

doi:10.1016/j.pediatrneurol.2014.11.008

Cited by 42 publications

(29 citation statements)

References 47 publications

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“…The difference in mean HC was significant between the drug-exposed and control groups but not between the detoxified and control groups. 25 Walhovd et al 26 reported that the MRI brain volumes did not differ at a mean age of 4.5 years in 12 newborns delivered to mothers who detoxified during pregnancy, resulting in an absence of NAS, compared with 12 controls. At present, detoxification during pregnancy is not recommended in the primary management of OUD in pregnancy 2 and has only been reported in a few locations (in both inpatient and outpatient settings) in the United States and other countries.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome

et al. 2018

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OBJECTIVES:To compare head circumference (HC) in neonates treated for neonatal abstinence syndrome (NAS) with control neonates without antenatal opioid exposure. METHODS:Our prospective cohort study ran from April 1, 2014, through December 31, 2016. Newborns treated for NAS delivered from well-dated pregnancies ≥34 weeks' gestation were compared with newborns who were nonopioid exposed and matched for race, parity, mode of delivery, and gestational age. All mothers underwent serial antenatal urine drug testing. A minimum of 754 study participants were needed (377 in each group) to demonstrate an increase in the proportion of newborns with HCs less than or equal to the 10th percentile from 10% in controls to a minimum of 20% in NAS newborns with 90% power. RESULTS:A total of 858 neonates were enrolled (429 NAS cases and 429 controls). Mean HC for cases was 33.04 cm (±1.9 cm) compared with 33.99 cm (±2.0 cm) for controls (P < .0001). Among the 429 NAS cases, the mothers of 372 (87%) were on opioid medicationassisted treatment. For NAS cases, 30.1% (95% confidence interval: 25.8%-34.7%) had an HC less than or equal to the 10th percentile (129 of 429 neonates), and 8.2% (95% confidence interval: 5.8%-11.2%) had an HC less than or equal to the third percentile (35 of 429 neonates). Multivariate analysis was used and determined that only chronic opioid use during gestation resulting in a neonate who was NAS treated was a significant risk factor for the observed smaller HC. CONCLUSIONS: Chronic opioid use during pregnancy sufficient to cause NAS was associated with smaller HCs at birth. Most mothers were on opioid agonist medication-assisted treatment, which is currently the recommended treatment option during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome

et al. 2018

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“…Infants born to mothers who are opioid abusers have been recently reported to have delayed or altered neuroanatomical maturation, with smaller cerebral volumes . Therefore, close multidisciplinary long‐term follow‐up is mandatory, focusing on neurodevelopmental, nutritional, psychobehavioral, and social aspects …”

Section: Follow‐up and Long‐term Outcomesmentioning

confidence: 99%

Neonatal Abstinence Syndrome: Update on Diagnostic and Therapeutic Strategies

et al. 2017

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Substance use among pregnant women is a major public health issue. Both prescription opioid use and illicit opioid abuse have increased dramatically in recent years. Prolonged in utero drug exposure may result in neonatal abstinence syndrome (NAS), an acute multisystemic clinical entity that occurs in the first days of life. This syndrome is caused by abrupt discontinuation of fetal exposure to licit or illicit drugs chronically consumed by the mother during pregnancy and transmitted to the fetus through the placenta. It usually requires prolonged hospitalization and may have long-term effects. The interplay of many factors contributes to its clinical heterogeneity, and its pathophysiology has not been fully unveiled. The first step in NAS management consists of nonpharmacologic interventions and includes promoting breastfeeding when not contraindicated. If withdrawal signs become severe, pharmacotherapy is needed. The Finnegan scoring system supports care providers across the pharmacotherapy process from initiation through the monitoring phase, until weaning and discontinuation. However, a standardized approach to pharmacotherapy is still lacking. Morphine is usually the first-line agent to treat NAS. Methadone is a valid option, but its safety profile is not completely known. Phenobarbital, despite its lack of effect on gastrointestinal symptoms and unfavorable pharmacologic features, has been identified as a second-line agent to be used in infants unresponsive to opiates. Although buprenorphine and clonidine seem promising, their use requires further validation. Long-term developmental effects of NAS therapy call for more-comprehensive, longitudinal assessments. In this article, key points for use of recommended therapies are outlined, and directions for future research are suggested.

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“…Three of these studies were secondary analyses of data from larger studies that met inclusion criteria and were thus excluded to avoid duplicating data. 16–18 Fifteen studies were included in the qualitative synthesis (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…30 Neuroanatomic, neurocognitive, and visual acuity outcomes from Haabrekke were reported for 12 children at 4.5 years of age in Walhovd. 18 A detailed summary of maternal and neonatal outcomes reported by included studies is described in Appendices 3 and 4, available online at http://links.lww.com/AOG/B79.…”

Section: Resultsmentioning

confidence: 99%

Opioid Detoxification During Pregnancy

Terplan

Laird

Hand

et al. 2018

Obstetrics &Amp; Gynecology

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OBJECTIVE To systematically review maternal and neonatal outcomes associated with opioid detoxification during pregnancy. DATA SOURCES PubMed, PsycINFO, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched from January 1, 1966, to September 1, 2016. METHODS OF STUDY SELECTION English-language studies that reported outcomes associated with opioid detoxification among pregnant women with opioid use disorder were included. Nonoriginal research articles (case reports, editorials, reviews) and studies that failed to report outcomes for detoxification participants were excluded. Bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias and quality was assessed using the U.S. Preventive Service Task Force Quality of Evidence scale. TABULATION, INTEGRATION, AND RESULTS Of 1,315 unique abstracts identified, 15 met criteria for inclusion and included 1,997 participants, of whom 1,126 underwent detoxification. Study quality ranged from fair to poor as a result of the lack of a randomized control or comparison arm and high risk of bias across all studies. Only nine studies had a comparison arm. Detoxification completion (9–100%) and illicit drug relapse (0–100%) rates varied widely across studies depending on whether data from participants who did not complete detoxification or who were lost to follow-up were included in analyses. The reported rate of fetal loss was similar among women who did (14 [1.2%]) and did not undergo detoxification (17 [2.0%]). CONCLUSIONS Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.

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Child Neuroanatomical, Neurocognitive, and Visual Acuity Outcomes With Maternal Opioid and Polysubstance Detoxification

Cited by 42 publications

References 47 publications

Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome

Neonatal Head Circumference in Newborns With Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome: Update on Diagnostic and Therapeutic Strategies

Opioid Detoxification During Pregnancy

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