Managing infants born to mothers who have used opioids during pregnancy

Abstract

The incidence of infant opioid withdrawal has grown rapidly in many countries, including Canada, in the last decade, presenting significant health and early brain development concerns. Increased prenatal exposure to opioids reflects rising prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies. Infants are at high risk for experiencing symptoms of abstinence or withdrawal that may require assessment and treatment. This practice point focuses specifically on the effect(s) of opioid withdrawal and current management strategies in the care of infants born to mothers with opioid dependency.

Rooming‐in and loss of child custody: key factors in maternal overdose risk

“…We agree that a compassionate, dyadic care environment for opioid-exposed mothers and infants during the delivery hospitalization can help support and maintain recovery in the early postpartum period. The innovative work led by Dr. Abrahams and colleagues in Vancouver at Sheway and Firsquare provides a blueprint that programs caring for families impacted by substance use should strive to emulate [2,3]. As Mackay describes, this includes parental ability to room-in while an infant is monitored for signs of neonatal opioid withdrawal.…”

“…Rooming-in, the practice of caring for mother and newborn together in the same room immediately from birth, is supported as standard practice by JAMA Pediatrics and the Canadian Pediatric Association for newborns of substance-using women. 2,3 Rooming-in is well supported by the literature and is associated with decreased severity and duration of neonatal abstinence syndrome (NAS), decreased newborn intensive care unit (NICU) admissions, shorter hospital stays, increased likelihood of breastfeeding during the hospital stay, decrease in loss of child custody and no increase in re-admission rates or hospital adverse events. [4][5][6][7][8] A population-based cohort study of 13 577 mothers in Canada and England found that mothers who had babies with NAS had an all-cause mortality rate 11-12 times greater than the control group in 10 years following delivery.…”

Clinical Opinion Letters Regarding Breastfeeding and Neonatal Abstinence Syndrome for Child Apprehension Family Court Proceedings

“…In Canada, the rate of NAS rose 27% between 2012–2013 and 2016–2017, and it is estimated that 0.51% of all infants now experience NAS after delivery (Canadian Institutes of Health Information, n.d. ; Lacze-Masmonteil, O’Flaherty, Canadian Pediatric Society, 2018).…”

Neonatal Abstinence Syndrome and Associated Neonatal and Maternal Mortality and Morbidity

“…11,12 Mother-infant bonding in the immediate postpartum period has proven to be beneficial to infant health and development, breastfeeding, and maternal attachment. [13][14][15][16] This is greatly facilitated by rooming-in, which has become the standard of care for infants with NAS. 16 Despite the recent increases in NAS, demographic and clinical characteristics of mother-infant dyads with NAS, including serious adverse maternal and infant health outcomes, have been understudied using large population data.…”

“…[13][14][15][16] This is greatly facilitated by rooming-in, which has become the standard of care for infants with NAS. 16 Despite the recent increases in NAS, demographic and clinical characteristics of mother-infant dyads with NAS, including serious adverse maternal and infant health outcomes, have been understudied using large population data. The extent of mortality and serious morbidity in these affected infants and their mothers has implications for postpartum care, mother-infant bonding, and health care resources.…”