Neonatal opiate abstinence syndrome in term and preterm infants

Doberczak, Tatiana M.; Kandal, Stephen R.; Wilets, Ilene

doi:10.1016/s0022-3476(05)82214-0

Cited by 161 publications

(99 citation statements)

References 14 publications

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“…In 1 study, abstinence scores of infants whose mothers abused cocaine and methadone were similar to the scores of infants whose mothers received high-dose maintenance methadone. 64 In another study, the neurobehavioral scores of infants exposed to intrauterine cocaine were similar to those of infants exposed to both cocaine and methadone. 80 Conversely, an unmasked study reported higher abstinence scores in infants exposed to both cocaine and heroin in comparison with those exposed to heroin or cocaine alone.…”

Section: Abuse Of Multiple Drugsmentioning

confidence: 87%

“…Infants born at <35 weeks' gestation whose mothers received methadone maintenance had significantly lower total and CNS abstinence scores than did term infants of mothers receiving similar methadone dosages. 64 In a more recent study, lower gestational age correlated with a lower risk of neonatal withdrawal. 68 The apparent decreased severity of signs in preterm infants may relate to developmental immaturity of the CNS, differences in total drug exposure, or lower fat depots of drug.…”

Section: Preterm Infantsmentioning

confidence: 91%

“…Some studies demonstrated that larger maternal methadone dosages in late pregnancy were associated with greater neonatal concentrations and increased risk of withdrawal, 8,9,[62][63][64][65][66][67][68] but others refuted a correlation. [69][70][71][72][73][74] This lack of consensus is explained in part by different approaches to the management of antenatal methadone maintenance therapy.…”

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confidence: 99%

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Neonatal Drug Withdrawal

Hudak¹,

Tan²,

Frattarelli³

et al. 2012

Pediatrics

757

608

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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.

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Section: Abuse Of Multiple Drugsmentioning

confidence: 87%

Section: Preterm Infantsmentioning

confidence: 91%

mentioning

confidence: 99%

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Neonatal Drug Withdrawal

Hudak¹,

Tan²,

Frattarelli³

et al. 2012

Pediatrics

757

608

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“…10,12 Brown et al 11 reported greater levels of irritability in preterm infants exposed to cocaine in utero. In our large cohort, we observed no relationship between the gestation and the development of NAS.…”

Section: Discussionmentioning

confidence: 99%

Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources

Dryden

Young

Hepburn

et al. 2009

BJOG

214

205

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Objectives The objectives of this study were to investigate factors associated with the development of neonatal abstinence syndrome (NAS) and to assess the implications for healthcare resources of infants born to drug-misusing women.Design Retrospective cohort study from 1 January 2004 to 31 December 2006.Setting Inner-city maternity hospital providing dedicated multidisciplinary care to drug-misusing women.Population Four hundred and fifty singleton pregnancies of drugmisusing women prescribed substitute methadone in pregnancy.Methods Case note review.Main outcome measures Development of NAS and duration of infant hospital stay.Results 45.5% of infants developed NAS requiring pharmacological treatment. The odds ratio of the infant developing NAS was independently related to prescribed maternal methadone dose rather than associated polydrug misuse. Breastfeeding was associated with reduced odds of requiring treatment for NAS (OR 0.55, 95% CI 0.34-0.88). Preterm birth did not influence the odds of the infant receiving treatment for NAS. 48.4% infants were admitted to the neonatal unit (NNU) 40% of these primarily for treatment of NAS. The median total hospital stay for all infants was 10 days (interquartile range 7-17 days). Infants born to methadone-prescribed drug-misusing mothers represented 2.9% of hospital births, but used 18.2% of NNU cot days.Conclusions Higher maternal methadone dose is associated with a higher incidence of NAS. Pregnant drug-misusing women should be encouraged and supported to breastfeed. Their infants are extremely vulnerable and draw heavily on healthcare resources.Keywords Breastfeeding, health resources, methadone, neonatal abstinence syndrome.

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“…1,2 Moderate to severe neonatal withdrawal is associated with increased mortality and morbidity 3,4 and is typically treated with low-dose opiates (paregoric, tincture of opium) or barbiturates (phenobarbital) and behavioral interventions such as swaddling, rocking, and increased feeding. 5,6 Even when treated aggressively, neonatal withdrawal can require lengthy intervention and persist for weeks in a subacute form. 7,8 Over the past 25 years, numerous studies have confirmed that infants laid prone enjoy a range of behavioral and physiological advantages.…”

Section: Discussionmentioning

confidence: 99%

Use of Positioning to Reduce the Severity of Neonatal Narcotic Withdrawal Syndrome

1999

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OBJECTIVE:This study tested the hypothesis that highly fretful, narcotic-withdrawing neonates experience less distress in a prone-lying position than comparable, supine-lying neonates. STUDY DESIGN:Equivalent numbers of randomly assigned, narcotic-withdrawing newborns were assigned to prone-lying (n ϭ 25) or supine-lying (n ϭ 23) conditions. Subjects in the two groups were similar with regard to gestational age, birth weight, and clinical presentation. Peak and mean withdrawal severity, as measured by Neonatal Abstinence Scoring System (NASS) scores and daily caloric intake, were compared between supine and prone groups by Wilcoxon's two-sample test. RESULTS:The prone-lying neonates had lower peak NASS scores (p Ͻ 0.0001), lower mean NASS scores (p Ͻ 0.0001), and lower caloric intake (p Ͻ 0.001) than supine-lying, narcotic-withdrawing newborns. CONCLUSION:The fretfulness associated with neonatal withdrawal and other stressful conditions can be moderated by laying the affected infant prone. The pronate quieting response is a significant, endogenous source of neonatal pacification.Within the first days of life, most infants born to narcotic-dependent women experience a stressful withdrawal syndrome marked by tremor, sleeplessness, hypertonia, irritability, and autonomic and gastrointestinal symptoms. 1,2 Moderate to severe neonatal withdrawal is associated with increased mortality and morbidity 3,4 and is typically treated with low-dose opiates (paregoric, tincture of opium) or barbiturates (phenobarbital) and behavioral interventions such as swaddling, rocking, and increased feeding. 5,6 Even when treated aggressively, neonatal withdrawal can require lengthy intervention and persist for weeks in a subacute form. 7,8 Over the past 25 years, numerous studies have confirmed that infants laid prone enjoy a range of behavioral and physiological advantages. The positive consequences of prone position for sleep include: fewer awakenings and increased time in quiet sleep, 9,10 more sleep with higher arousal thresholds, 11-13 lower levels of activity, 14,15 enhanced respiratory control, 16 -18 and diminished heart rate variability. 11,17 Newborns laid prone cry much less than supine-lying infants 11 and have decreased energy requirements. 19 -21 Although the precise physiological mechanism constituting the pronate quieting response has not been elucidated, the phenomenon has been put to good purpose by investigators concerned with preserving the preterm or high-risk infant's often precarious metabolic margin. [22][23][24] Interestingly, the pronate quieting response has not been investigated with infants who are among the most consistently fretful, sleep-fractured of newborns -infants withdrawing from prenatal exposure to narcotics.We hypothesized that newborns undergoing neonatal withdrawal, an acutely stressful, protracted, excitability syndrome, would be positively affected by position; we predicted that withdrawing newborns laid prone (face down) for sleep would be less symptomatic than similar neonates laid supine...

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Neonatal opiate abstinence syndrome in term and preterm infants

Cited by 161 publications

References 14 publications

Neonatal Drug Withdrawal

Neonatal Drug Withdrawal

Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources

Use of Positioning to Reduce the Severity of Neonatal Narcotic Withdrawal Syndrome

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