Neonatal Abstinence Syndrome: A Challenge for Medical Providers, Mothers, and Society

Thigpen, Jim; Melton, Sarah T.

doi:10.5863/1551-6776-19.3.144

Cited by 7 publications

(4 citation statements)

References 7 publications

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“…Maternal substance use and addiction may present medical, legal and economic consequences for the mother 28 . Opioid addiction is associated with lower maternal socioeconomic status, co‐morbidities such as HIV or Hepatitis C and exposure to violence 29,30 .…”

Section: Resultsmentioning

confidence: 99%

The Effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review

Corsi

Murphy

2021

Basic Clin Pharma Tox

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Opioids cover a broad class of natural, synthetic and semi‐synthetic drugs that act on opioid receptors to produce powerful analgesic effects. Rates of opioid use and opioid agonist maintenance treatment have increased substantially in recent years, particularly among women. Trends and outcomes of opioids use on fertility, pregnancy and breastfeeding, and longer‐term child developmental outcomes have not been well‐described. Here, we review the existing literature on the health effects of opioid use on female fertility, pregnancy, breastmilk and the exposed infant. We find that the current literature is primarily concentrated on the impact of opioid use in pregnancy and neonatal outcomes, with little exploration of effects on fertility. Studies are limited in number, some with small sample sizes, and many are hampered by methodological challenges related to confounding and other potential biases. Opioid use is becoming more prevalent due to environmental pressures such as COVID‐19. More research is needed to better elucidate its effects on reproductive health among younger women and support the development of evidence‐based recommendations for safe prescription practices and public health messaging.

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Section: Resultsmentioning

confidence: 99%

The Effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review

Corsi

Murphy

2021

Basic Clin Pharma Tox

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“…Methadone-associated NAS often requires prolonged hospitalization and high postnatal cumulative opioid treatment. Evidence has shown early identification of neonates in need for pharmacological treatment and optimal dosing strategy may decrease the severity of NAS and length of stay [10,[35][36][37]. However, when based on clinical tools like the FNAS, recognition of NAS in preterm neonates is substandard [13].…”

Section: Discussionmentioning

confidence: 99%

Pharmacometric Evaluation of Umbilical Cord Blood Concentration-Based Early Initiation of Treatment in Methadone-Exposed Preterm Neonates

et al. 2021

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In methadone-exposed preterm neonates, early identification of those at risk of severe neonatal abstinence syndrome (NAS) and use of a methadone dosing regimen that can provide effective and safe drug exposure are two important aspects of optimal care. To this end, we reviewed 17 methadone dosing recommendations in the international guidelines and literature and explored their variability in key dosing strategies. We selected three of the reviewed dosing regimens for their pharmacokinetics (PK) characteristics and their exposure–response relationship in three gestational age groups of preterm neonates (28, 32 and 36 gestational age weeks) at risk for development of severe NAS (defined as an umbilical cord methadone concentration of £ 60 ng/mL, following fetal exposure). We applied early (12 h after birth) vs. typical (36 h after birth) initiation of treatment. We observed that use of universally recommended dosing regimens in preterm neonates can result in under- or over-exposure. Use of a PK-guided dosing regimen resulted in effective target exposures within 24 h after birth with early initiation of treatment (12 h after birth). Future prospective studies should explore the incorporation of umbilical cord methadone concentrations for early identification of preterm neonates at risk of developing severe NAS and investigate the use of a PK-guided methadone dosing regimen, so that treatment failure, prolonged length of stay and opioid over-exposure can be avoided.

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“…Manifesting as acute withdrawal, NAS may result in dysregulation of the autonomic nervous system and cause issues with sensory processing, attention, and motor control. 38 These conditions may be further exacerbated by symptoms that the mother may be experiencing, including peripartum pain or withdrawal, all of which can contribute to impeded maternal-infant bonding. [15][16][17] Longterm neurodevelopment outcomes in the child have not been clearly outlined.…”

Section: Neonatal Abstinence Syndrome (Nas)mentioning

confidence: 99%

Multimodal Acute Pain Management in the Parturient with Opioid Use Disorder: A Review

Koltenyuk,

Mrad,

Choe

et al. 2024

JPR

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The opioid epidemic in the United States has led to an increasing number of pregnant patients with opioid use disorder (OUD) presenting to obstetric units. Caring for this complex patient population requires an interdisciplinary approach involving obstetricians, anesthesiologists, addiction medicine physicians, psychiatrists, and social workers. The management of acute pain in the parturient with OUD can be challenging due to several factors, including respiratory depression, opioid tolerance, and opioid-induced hyperalgesia. Patients with a history of OUD can present in one of three categories: 1) those with untreated OUD; 2) those who are currently abstinent from opioids; 3) those being treated with medications to prevent withdrawal. A patient-centered, multimodal approach is essential for optimal peripartum pain relief and prevention of adverse maternal and neonatal outcomes. Medications for opioid use disorder (MOUD), previously referred to as medication-assisted therapy (MAT), include opioids like methadone, buprenorphine, and naltrexone. These are prescribed for pregnant patients with OUD, but appropriate dosing and administration of these medications are critical to avoid withdrawal in the mother. Non-opioid analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used in a stepwise approach, and regional techniques like neuraxial anesthesia and truncal blocks offer opioid-sparing options. Other medications like ketamine, clonidine, dexmedetomidine, nitrous oxide, and gabapentinoids show promise for pain management but require further research. Overall, a comprehensive pain management strategy is essential to ensure the well-being of both the mother and the fetus in pregnant patients with OUD.

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Neonatal Abstinence Syndrome: A Challenge for Medical Providers, Mothers, and Society

Cited by 7 publications

References 7 publications

The Effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review

The Effects of opioids on female fertility, pregnancy and the breastfeeding mother‐infant dyad: A Review

Pharmacometric Evaluation of Umbilical Cord Blood Concentration-Based Early Initiation of Treatment in Methadone-Exposed Preterm Neonates

Multimodal Acute Pain Management in the Parturient with Opioid Use Disorder: A Review

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