Neonatal Drug Withdrawal

Abstract

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.

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

“…The little available evidence from controlled trials of neonatal opioid withdrawal lends support for the use of oral morphine solution and methadone when pharmacological treatment is indicated; increasing evidence suggests that oral clonidine is also eff ective either as a primary or adjunctive treatment, but further prospective trials are warranted. 54 Interpretation of our results must be tempered by the limitations. First, the participation of eligible units varied widely between countries and might not represent each country's practices.…”

“…For example, setting a threshold at a cumulative fentanyl exposure of more than 2 mg/kg or for longer than 7 days would predict a likelihood of dependency of more than 50% but less than 100%. 54 Infants with a cumulative exposure to opioids or benzodiazepines below the thresholds for initiation of weaning protocols can have a rapid taper of these medications over 24-48 h; those above the thresholds might need longer weaning of up to 2-3 weeks. 54 The AAP also recommends that signs of drug withdrawal be scored with a validated abstinence assessment scale.…”

Determining the reliability of the Withdrawal Assessment Tool-1 in comparison to the Neonatal Drug Withdrawal Scoring System

“…[3] In addition, neonates that are exposed to intrauterine drugs can also manifest symptoms of withdrawal if not promptly and adequately managed. [4] Characteristics of withdrawal symptoms in a child can present as behavioral or physiologic changes. Behavioral symptoms of withdrawal can include anxiety, agitation, difficulty sleeping, and tremors.…”

“…[1] The other is iatrogenic withdrawal, which can occur when a baby or child is treated with opioids or benzodiazepines and the medication is abruptly discontinued or tapered and withdrawal symptoms are present. [4] Unfortunately, the majority of the research to date focuses on neonatal abstinence syndrome; however, iatrogenic withdrawal is becoming an increasing concern for many because its prevalence is on the rise. In 2009, approximately 7.2 million outpatient opioid prescriptions were written for children in the United States.…”

“…[4] However, in 2012, the AAP guidelines for neonatal drug withdrawal were modified to recommend Finnegan's Neonatal Abstinence Scoring instrument. [4] Furthermore, the AAP expanded their guidelines to cover iatrogenic withdrawal in addition to NAS.…”