Pharmacologic observations on the neonatal withdrawal syndrome

Rosen, Tove S.; Pippenger, C. E.

doi:10.1016/s0022-3476(76)81074-8

Cited by 93 publications

(52 citation statements)

References 10 publications

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“…36 Previous studies investigating the influence of prescribed maternal methadone dose upon the development of NAS have yielded conflicting results. 9,[13][14][15][16][17][18][19] The largest of these studies included 100 infants. 15 Other studies have spanned more than a decade and been confounded by cocaine and heroin use.…”

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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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

View full text Add to dashboard Cite

show abstract

“…The high doses in our cohort are partially a reflection of the amount of heroin use in our cohort and relative differences in the potency of different varieties of heroin. The best explanation for why methadone dose and length of treatment are unrelated is because methadone metabolism is enhanced to variable degrees in the pregnancy (15). In fact methadone trough levels do not correlate well with maternal dosage (24), so that maternal methadone dose should be decided based on maternal symptoms, with no predetermined maximum.…”

Section: Commentmentioning

confidence: 99%

“…Initiating pharmacologic treatment for NAS decreases the duration of symptoms (2) but does not subjugate the necessity to decrease the severity of withdrawal through antenatal interventions. The majority of literature on methadone administration is concentrated on dosage and the findings regarding an association between maternal methadone dose and the severity of neonatal withdrawal conflict (6,8,9,10,11,12,13,14,15). The optimal dose remains a topic of clinical debate.…”

Section: Introductionmentioning

confidence: 99%

Predicting length of treatment for neonatal abstinence syndrome in methadone-exposed neonates

Seligman

Salva

Hayes

et al. 2008

American Journal of Obstetrics and Gynecology

114

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“…[1][2][3] Among infants exposed to chronic opiates in utero, the incidence of neonatal abstinence syndrome (NAS) ranges from 21 to 94%. [4][5][6] The onset, duration and severity of NAS may be impacted by the types and degree of fetal drug exposure and by neonatal treatment strategies, [7][8][9][10][11][12][13] use of tobacco during pregnancy, 14 gestational age 15,16 and use of maternal breast milk (MBM) as the primary source of nutrition. [17][18][19][20] The interactions of these factors and the composite impact on response to pharmacologic therapy for NAS have not been adequately elucidated in a large cohort of infants.…”

Section: Introductionmentioning

confidence: 99%

Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome

Isemann¹,

Meinzen‐Derr

Akinbi

2010

J Perinatol

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Objective: To identify maternal and neonatal factors that impact response to methadone therapy for neonatal abstinence syndrome.Study Design: This is a retrospective review of 128 infants that received pharmacotherapy for opiate withdrawal to identify factors associated with favorable response to methadone therapy. Maternal and neonatal data were analyzed with univariate statistics and multivariate logistic regression.Result: Maternal methadone maintenance dose during pregnancy correlated with length of stay (P ¼ 0.009). There was an inverse correlation between the amount of mother's breast milk ingested and length of stay (b ¼ À0.03, P ¼ 0.02). Methadone was initiated later, tapered more rapidly and was more successful as monotherapy in preterm infants. Five percent of infants were admitted to hospital again for rebound withdrawal following reduction of breast milk intake. Conclusion:Severity of neonatal abstinence syndrome may be mitigated by titrating methadone to the lowest effective dose during pregnancy and by encouraging breast milk feeds, which should be weaned gradually.

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Pharmacologic observations on the neonatal withdrawal syndrome

Cited by 93 publications

References 10 publications

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

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

Predicting length of treatment for neonatal abstinence syndrome in methadone-exposed neonates

Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome

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