Management of neonatal abstinence syndrome: a national survey and review of practice

O’Grady, Michael J.; Hopewell, Jayne; White, Martin

doi:10.1136/adc.2008.152769

Cited by 102 publications

(105 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…130,144 Phenobarbital does not prevent seizures at the dosage administered for withdrawal, nor does it improve gastrointestinal symptoms. However, phenobarbital is advantageous because it can be used as an adjuvant, especially in infants suffering withdrawal from polydrug abuse, 145 which is generally severe and prolonged. Clonidine, a centrally acting a-adrenergic receptor agonist, has been studied as a single replacement therapy or adjunct therapy, although the theoretical risk of hypotension and bradycardia may always prohibit increasing its dose.…”

Section: Pharmacological Carementioning

confidence: 99%

See 1 more Smart Citation

Neonatal Abstinence Syndrome

2014

View full text Add to dashboard Cite

Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

show abstract

Section: Pharmacological Carementioning

confidence: 99%

“…127,145 Morphine decreases the incidence of seizures, improves feeding, eliminates diarrhea, decreases agitation, and can control severe symptoms. 146 However, morphine treatment also prolongs the length of hospital stay.…”

Section: Pharmacological Carementioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

View full text Add to dashboard Cite

show abstract

“…The majority of practitioners use phenobarbital as a second drug if the opiate does not adequately control withdrawal signs. 102,113 Daily doses of morphine ranged from 0.24 mg/kg per day to 1.3 mg/kg per day. 113 Paregoric is no longer used, because it contains variable concentrations of other opioids, as well as toxic ingredients such as camphor, anise oil, alcohol, and benzoic acid.…”

Section: Rationale and Comparative Evidence For Pharmacologic Treatmentmentioning

confidence: 99%

“…102,113 Daily doses of morphine ranged from 0.24 mg/kg per day to 1.3 mg/kg per day. 113 Paregoric is no longer used, because it contains variable concentrations of other opioids, as well as toxic ingredients such as camphor, anise oil, alcohol, and benzoic acid. 100 The use of diazepam has also fallen into disfavor because of a documented lack of efficacy compared with other agents and because of its adverse effects on infant suck and swallow reflexes.…”

Section: Rationale and Comparative Evidence For Pharmacologic Treatmentmentioning

confidence: 99%

Neonatal Drug Withdrawal

Hudak¹,

Tan²,

Frattarelli³

et al. 2012

Pediatrics

757

608

View full text Add to dashboard Cite

Maternal use of certain drugs during pregnancy can result in transient neonatal signs consistent with withdrawal or acute toxicity or cause sustained signs consistent with a lasting drug effect. In addition, hospitalized infants who are treated with opioids or benzodiazepines to provide analgesia or sedation may be at risk for manifesting signs of withdrawal. This statement updates information about the clinical presentation of infants exposed to intrauterine drugs and the therapeutic options for treatment of withdrawal and is expanded to include evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.

show abstract

“…5 Despite recommendations from the American Academy of Pediatrics 6 that opioids are the first-line therapy for NAS, variation exists among centers in the treatment of NAS. 5,7,8 It also remains unclear how opiate treatment of NAS affects children's long-term outcomes.…”

Section: What's Known On This Subjectmentioning

confidence: 99%

Morphine Versus Clonidine for Neonatal Abstinence Syndrome

Bada¹,

Sithisarn²,

Gibson

et al. 2015

Pediatrics

View full text Add to dashboard Cite

OBJECTIVE: The study goal was to determine whether clonidine treatment of neonatal abstinence syndrome (NAS) would result in a better neurobehavioral performance compared with morphine.METHODS: This pilot study prospectively enrolled infants $35 weeks' gestational age admitted for treatment of NAS. After informed consent was obtained, infants were randomized to receive morphine (0.4 mg/kg per day) or clonidine (5 mg/kg per day) divided into 8 doses. A 25% dose escalation every 24 hours was possible per protocol (maximum of 1 mg/kg per day for morphine and 12 mg/kg per day for clonidine). After control of symptoms, the dose was tapered by 10% every other day. Clinical staff monitored infants by using Finnegan scoring. Masked research staff administered the NICU Network Neurobehavioral Scale (NNNS) at 1 week and at 2 to 4 weeks after initiation of treatment and the Bayley Scales III, and Preschool Language Scale IV, at 1-year adjusted age. Analyses included descriptive statistics, repeated measures analysis of variance, and Wilcoxon tests.RESULTS: Infants treated with morphine (n = 15) versus clonidine (n = 16) did not differ in birth weight or age at treatment. Treatment duration was significantly longer for morphine (median 39 days) than for clonidine (median 28 days; P = .02). NNNS summary scores improved significantly with clonidine but not with morphine. On subsequent assessment, those receiving clonidine had lower height of arousal and excitability (P , .05). One-year motor, cognitive, and language scores did not differ between groups.CONCLUSIONS: Clonidine may be a favorable alternative to morphine as a single-drug therapy for NAS. A multicenter randomized trial is warranted. WHAT'S KNOWN ON THIS SUBJECT:Increased central adrenergic activity occurs with opiate withdrawal. Clonidine is an effective drug as an adjunct to morphine in the treatment of neonatal abstinence syndrome. It is unclear whether clonidine is effective as single-drug therapy.WHAT THIS STUDY ADDS: Clonidine, a a 2 -adrenergic agonist, seems to be as effective as morphine when used as a single-drug therapy for neonatal abstinence syndrome. Its administration results in improvement in neurobehavioral performance.

show abstract

Management of neonatal abstinence syndrome: a national survey and review of practice

Abstract: The majority of units currently use an opiate as the drug of first choice as recommended. Doses utilised and second agents added vary significantly between units. Many of our findings reflect the lack of high-quality randomised studies regarding management of NAS.

Cited by 102 publications

References 39 publications

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome

Neonatal Drug Withdrawal

Morphine Versus Clonidine for Neonatal Abstinence Syndrome

Contact Info

Product

Resources

About