Maternal and iatrogenic neonatal opioid withdrawal syndrome: Differences and similarities in recognition, management, and consequences

Abstract

Opioids are potent analgesics, and have been used for their psychoactive properties for centuries. Chronic and widespread opioid use, however, has significant individual and societal implications. In 2015, over two million Americans struggled with opioid use disorder (Hedegaard et al., 2020). Among this population are pregnant women, contributing to a surge in in utero opioid exposure from both prescription and illicit opioid use (Haight et al., 2018), and adverse neonatal outcomes. The incidence of neonatal opioid withdrawal syndrome (NOWS), or neonatal abstinence syndrome (NAS),

Iatrogenic Withdrawal Syndrome in Critically Ill Neonates: A Review of Mechanisms, Assessment, Management, and Prevention

“…When a molecule binds to an opioid receptor in the ascending pain pathway hyperpolarization of neurons in the spinal cord stimulates postsynaptic potassium channels decreasing their probability of firing action potentials. 9 In the descending pain pathway, the activation of opioid receptors in the brainstem leads to stimulation of regions responsible for pain modulation, known as the periaqueductal gray and the rostral ventromedial medulla. These regions can inhibit pain by reducing the excitability of neurons in the spinal cord through the release of monoamines such as noradrenaline.…”

“…In short, the basic effect of administered opioids is to reduce the firing of action potentials that signal pain. 9 When opioid cessation occurs, several body systems can be affected and manifest the known complication of dependency. An example is the locus coeruleus (LC), a structure located at the base of the brain and responsible for autonomic regulation through noradrenergic circuits.…”

“…25 Among the limitations of the FNAS are its purpose that does not include recognition of IWS 27 and its outdated nature (1975) that requires the use of modified versions. 9 In addition, it was designed to evaluate neonates born to mothers addicted to opioids, not the use of benzodiazepines thereby limiting its use in the management of IWS. 25,27 Therefore, despite its application to assess IWS in prior studies, 11,25 FNAS may not be well suited for this use.…”

“…However, some studies suggest that, for opioid analgesia, the younger the patient, the greater the risk of dependency. 9 Among pediatric patients in general, the incidence of IWS also varies depending on the duration of analgo-sedation. It is estimated that it affects around 50% of patients that receive drug infusion for ≥24 hours and may reach 80 to 100% when drug administration lasts more than 5 days.…”

“…When a molecule binds to an opioid receptor in the ascending pain pathway hyperpolarization of neurons in the spinal cord stimulates postsynaptic potassium channels decreasing their probability of firing action potentials. 9…”