Neonatal abstinence syndrome

Grossman, Matthew; Berkwitt, Adam

doi:10.1053/j.semperi.2019.01.007

Cited by 44 publications

(44 citation statements)

References 154 publications

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“…Reports have suggested that infants exposed to prenatal opioids are born small for gestational age, have smaller head circumference, and reduced neurocognitive performance in childhood 44–46 . Furthermore, the impact of prolonged pharmacotherapy with opioid on long‐term developmental outcomes are not clearly understood 7,12,13 . As future work, the developed model will be utilized to explore alternate morphine dosing protocols to reduce the overall time on pharmacological treatment thereby decreasing the burden of opioids on the developing brains of the newborn leading to improved clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Unstructured protocols for pharmacotherapy initiation and weaning have been associated with poor outcomes 9,11 (47% longer mean duration of opioid treatment and 33% longer mean length of stay (LOS) 11 ) as compared with use of structured protocols. Although use of structured protocols is promising, there are significant gaps in knowledge concerning the optimal treatment strategy and the impact of prolonged pharmacotherapy with opioid on long‐term developmental outcomes 7,12,13 . There is considerable heterogeneity regarding the dosing of morphine, clinical threshold for initiating treatment, starting doses, weaning protocol, and adjunctive medications 1,14 .…”

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confidence: 99%

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Model‐Based Approach to Improve Clinical Outcomes in Neonates With Opioid Withdrawal Syndrome Using Real‐World Data

Wijekoon

Aduroja

Biggs

et al. 2020

Clin Pharma and Therapeutics

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At least 60% of the neonates with opioid withdrawal syndrome (NOWS) require morphine to control withdrawal symptoms. Currently, the morphine dosing strategies are empiric, not optimal and associated with longer hospital stay. The aim of the study was to develop a quantitative, model-based, real-world data-driven approach to morphine dosing to improve clinical outcomes, such as reducing time on treatment. Longitudinal morphine dose, clinical response (Modified Finnegan Score (MFS)), and baseline risk factors were collected using a retrospective cohort design from the electronic medical records of neonates with NOWS (N = 177) admitted to the University of Maryland Medical Center. A dynamic linear mixed effects model was developed to describe the relationship between MFS and morphine dose adjusting for baseline risk factors using a split-sample data approach (70% training: 30% test). The training model was evaluated in the test dataset using a simulation based approach. Maternal methadone and benzodiazepine use, and race were significant predictors of the MFS response. Positive autocorrelations of 0.56 and 0.12 were estimated between consecutive MFS responses. On an average, for a 1,000 μg increase in the morphine dose, the MFS decreased by 0.3 units. The model evaluation showed that observed and predicted median time on treatment were similar (13.0 vs. 13.8 days). A model-based framework was developed to describe the MFSmorphine dose relationship using real-world data that could potentially be used to develop an adaptive, individualized morphine dosing strategy to improve clinical outcomes in infants with NOWS. Neonatal opioid withdrawal syndrome (NOWS), also known as neonatal abstinence syndrome, is a drug withdrawal syndrome experienced by 55-94% of in utero opioid-exposed neonates shortly after birth. 1 The dramatic increase of opioid use in pregnancy has led to a 5-fold increase in NOWS with an incidence of 1.5-8.0 per 1,000 hospital births from 2004 to 2014. 2-4 On average in the United States, 1 infant is born every

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Model‐Based Approach to Improve Clinical Outcomes in Neonates With Opioid Withdrawal Syndrome Using Real‐World Data

Wijekoon

Aduroja

Biggs

et al. 2020

Clin Pharma and Therapeutics

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“… 3 , 9 However, there have been no clinical studies addressing whether long medication weans are necessary or effective. 113 Moore et al 74 proposed that their population PK‐PD model of buprenorphine may serve as a starting point for a rational approach to weaning that allows changing of dosing frequency. Similarly, Mizuno et al 75 developed a buprenorphine population PK‐PD model in NOWS.…”

Section: Current Dosing and Pharmacometrics‐driven Dosing Optimization In Nowsmentioning

confidence: 99%

Clinical pharmacology and dosing regimen optimization of neonatal opioid withdrawal syndrome treatments

Tang

Bada

et al. 2021

Clinical Translational Sci

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“…MedLine Via Ovid SP (1946 – present) identified one paper relevant to the clinical question 1 . Embase Via Ovid SP (1947 – present) identified six papers, including four narrative reviews on the pharmacological treatment of NAS and two systematic reviews/meta‐analyses 2–7 . A search of three pre‐filtered databases (TRIP Database, UpToDate and Dynamed) using the terms ‘Neonatal Abstinence Syndrome’ did not yield any additional relevant papers.…”

Section: Search Strategymentioning

confidence: 99%

Does the addition of clonidine to opioid therapy improve outcomes in infants with Neonatal Abstinence Syndrome?

D'Abaco

2021

J Paediatrics Child Health

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To undertake a literature search and critical appraisal of best available evidence to answer the clinical question: Does the addition of clonidine (I) to standard treatment with an opioid (C) improve outcomes (O) in infants with Neonatal Abstinence Syndrome? A search of both comprehensive (MedLine and Embase) and pre-filtered databases (Dynamed, UpToDate and TRIP), utilising Boolean Operators to combine search terms appropriately. Three relevant studies were identified. One paper describing the outcomes of a randomised controlled trial by Agthe et al. (2009) most accurately answered the clinical question posed. This paper was critically appraised, and evidence applied to the clinical scenario. The use of clonidine as an adjunct to opioid in the management of infants with NAS reduces the total number of treatment days and dose of opioid required to control symptoms. However, there is a higher risk of rebound in symptoms post-cessation of opioid and clinicians need to account for this in their discharge planning. More large scale, multi-centre high-quality research is needed to clarify the role of clonidine in the treatment of NAS: as monotherapy versus adjunct, the optimal dose and longer-term impact on neurodevelopment.

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Neonatal abstinence syndrome

Cited by 44 publications

References 154 publications

Model‐Based Approach to Improve Clinical Outcomes in Neonates With Opioid Withdrawal Syndrome Using Real‐World Data

Model‐Based Approach to Improve Clinical Outcomes in Neonates With Opioid Withdrawal Syndrome Using Real‐World Data

Clinical pharmacology and dosing regimen optimization of neonatal opioid withdrawal syndrome treatments

Does the addition of clonidine to opioid therapy improve outcomes in infants with Neonatal Abstinence Syndrome?

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