Prevalence Of Neonatal Abstinence Syndrome Research Articles

A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome.

The prevalence of neonatal abstinence syndrome is increasing, but the number and quality of clinical practice guidelines available are unknown. This systematic review aimed to identify, appraise and evaluate clinical practice guidelines for neonatal abstinence syndrome. A systematic search of databases and the grey literature was conducted between 1 June and 1 July 2022. Full-text guidelines published by national or state-wide institutions were included. The recommendations from each guideline were extracted. The AGREE-II instrument was used to assess guideline quality. Sufficient-quality scores were defined as >60 and good-quality scores were >80 for each domain of AGREE-II. A total of 1703 records were identified, and 22 guidelines from the United States, Australia, Canada and the United Kingdom, published between 2012 to 2021, were included. The quality scores were low, with median scores of 37/100 for stakeholder involvement, 33/100 for methodology, 34/100 for applicability and 0 for editorial independence. Scope and purpose scored 72/100, and presentation scored 85/100. Sixteen (73%) guidelines did not meet the cut-offs for clinical use. Many guidelines were of insufficient quality to guide clinical practice for neonatal abstinence syndrome. This emphasises the need for high-quality studies to inform clinical practice guidelines, improve care and reduce the risk of poor outcomes in these high-risk infants.

Postpartum Contraceptive Use, Pregnancy Intentions in Women With and Without a Delivery of a NAS-Affected Infant in Delaware, 2012-2018.

Assess differences in postpartum contraceptive use and pregnancy intentions in women with a recent live birth who delivered a neonatal abstinence syndrome (NAS) affected infant. Using linked Delaware Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 (n = 6,358 singleton births), we assessed differences among women with and without a delivery of an NAS-affected infant by effective postpartum contraceptive use and pregnancy intentions. We calculated prevalence estimates, crude (cPOR), and prevalence odds ratios adjusted (aPOR) for NAS by maternal characteristics. We used alpha ≤ 0.05 to determine statistical significance. Prevalence of NAS was 2.2% (95% CI: 1.8 - 2.6). Effective postpartum contraceptive use was 60.4% (95% CI: 51.9-69.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 56.4% (95% CI: 55.1-57.8%) and cPOR was 1.2 (95% CI: 0.8-1.7). Prevalence of intended pregnancy was 26.5% (95% CI: 18.9-34.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 53.0% (95% CI: 51.7-54.4) and cPOR was 0.3 (95% CI: 0.2-0.5). After adjustment, women who delivered an NAS-affected infant had lower odds (aPOR = 0.5; 95% CI: 0.3-0.8) of indicating that their pregnancy was intended as compared to those who did not deliver an NAS-affected infant. Our study found no association between delivery of an NAS-affected infant and use of an effective postpartum contraceptive method. However, we found that pregnancy intendedness was lower among women delivering an NAS-affected infant compared with women without an NAS delivery even after accounting for maternal characteristics.

Outcomes of Neonates Exposed to Buprenorphine versus Methadone in Utero: A Systematic Review and Meta-Analysis of Safety in the Fetus and Neonate

We assessed the prevalence of neonatal abstinence syndrome (NAS) and fetal growth outcomes in neonates exposed to methadone compared to buprenorphine in utero. Three authors assessed the titles and abstracts of all potentially eligible studies. The selection criteria were randomized controlled trials and observational cohort studies from January 2000 to January 2020 which indexed and reported original data for occurrence of NAS and fetal growth outcomes in pregnant people who received methadone vs. buprenorphine treatment. The quality and possible bias of each study was assessed using the Cochrane-risk-of-bias tool. Data were pooled to compare the occurrence of NAS and fetal growth restriction among women who received methadone vs. buprenorphine treatment. Of the 106 articles screened, 1 randomized controlled trial and 5 observational cohort studies including 2041 pregnancies fulfilled the inclusion criteria. Buprenorphine is associated with less NAS and improved growth outcomes compared to methadone. (OR = 0.515; p-value < 0.001). Compared to methadone, buprenorphine is associated with less adverse neonatal outcomes in terms of gestational age at birth, birthweight, and head circumference. With the prevalence of NAS continuing to rise, this study adds to the expanding academic research aimed at creating safer treatment protocols.

Recovering Together: Mothers' Experiences Providing Skin-to-Skin Care for Their Infants With NAS.

Over the past 2 decades, the prevalence of neonatal abstinence syndrome (NAS) has increased almost 5-fold. Skin-to-skin care (SSC), a method of parent-infant holding, is a recommended nonpharmacologic intervention for managing NAS symptoms. SSC has the potential to reduce withdrawal symptoms while positively influencing parent-infant attachment. Yet, little is known about the SSC experiences of mothers of infants with NAS. The purpose of this study was to explore the SSC experiences of mothers of infants with NAS, including perceived barriers to SSC in the hospital and following discharge home. A qualitative descriptive design was used to obtain new knowledge regarding the experience of SSC of mothers of infants with NAS. Purposive sampling was used to recruit participants eligible for the study. We conducted semistructured individual interviews with postpartum mothers of infants with NAS. Data were analyzed using thematic analysis. Thirteen mothers participated in the study. Four themes emerged from the data analysis: "a little nerve racking"; "she needed me, and I needed her"; dealing with the "hard times"; and "a piece of my puzzle is missing." SSC was described as a conduit for healing and bonding; in addition, several barriers to SSC were reported. These findings highlight the inherent benefits of SSC for infants with NAS and demonstrate the unique challenges of these mother-infant dyads. Critical changes in hospital practices are needed to create an environment supportive of SSC for this patient population. In addition, research regarding implementation of interventions to increase SSC usage in this population is warranted.

Long-term mortality risk in mothers of infants with neonatal abstinence syndrome: an international cohort study in England and Canada

BackgroundOpioid addiction is a major public health issue, but little is known about long-term mortality for mothers with opioid use in pregnancy. The prevalence of neonatal abstinence syndrome is high in England and Ontario (Canada). We aimed to compare maternal mortality among mothers of infants with and without neonatal abstinence syndrome in these regions. MethodsIn this population-based study, we used administrative data to obtain parallel cohorts of linked mother–child records from singleton hospital births in England and Ontario between April 1, 2002, and Dec 31, 2012. Death records captured maternal mortality up to 10 years after delivery. We used neonatal abstinence syndrome as a marker of opioid-use during pregnancy. We modelled the association between neonatal abstinence syndrome and all-cause maternal mortality using Cox regression, and the cumulative incidence of cause-specific mortality within a competing risks framework. The primary exposure was neonatal abstinence syndrome among all mothers (aged 12–49 years) who had a live birth during the study period; mothers of infants without neonatal abstinence syndrome were controls. The main outcome was all deaths among mothers following index delivery. We estimated all-cause mortality rates, 10-year cumulative incidence risk of death, and crude and adjusted hazard ratios (HRs). FindingsThe study included 13 577 and 4 205 675 mothers of infants with neonatal abstinence syndrome in England and Ontario, respectively, and 4966 and 929 985 mothers of infants without neonatal abstinence syndrome in England and Ontario, respectively. 10-year mortality among mothers of infants with neonatal abstinence syndrome was 5·1% in England and 4·6% in Ontario compared with 0·4% in controls (both p<0·0001). Crude HRs for all-cause mortality were 12·1 (95% CI 11·1–13·2) in England and 11·4 (9·7–13·4) in Ontario. Compared with controls, the cumulative incidence of death was higher among mothers of infants with neonatal abstinence syndrome than mothers of infants without neonatal abstinence syndrome for almost all causes of death. Most deaths were due to avoidable causes. InterpretationApproximately one in 20 mothers of infants with neonatal abstinence syndrome died within 10 years of delivery in both England and Canada. Our study was limited by the paucity of direct measures of maternal opioid use and treatment. Policy responses to the current opioid epidemic require effective strategies for long-term support to improve the health and welfare of mothers who use opioids and their children. FundingInstitute for Clinical Evaluative Sciences, Ontario Ministry of Health and Long-Term Care.

Maternal Methadone Use and White Race are Associated with Increased Risk of Neonatal Abstinence Syndrome

Purpose: Neonatal Abstinence Syndrome (NAS) is a drug withdrawal syndrome experienced after birth by infants who were exposed to opioids in utero. Opioid use during pregnancy is increasing, resulting in an increase in NAS. Between 2000 and 2013, the prevalence of NAS increased from 0.9 to 3.9 per 1000 births in South Carolina. We aimed to identify factors that predict an opioid-exposed infant’s need for NAS treatment at a regional perinatal center in South Carolina. We hypothesized that the degree of maternal polysubstance drug …

Maternal prepregnancy surgery and risk of neonatal abstinence syndrome in future newborns: a longitudinal cohort study.

Neonatal abstinence syndrome is increasingly prevalent, and may be related to opioid use disorders caused by postoperative prescriptions for pain control. We assessed the association of maternal prepregnancy surgery with risk of neonatal abstinence syndrome from opioid use disorders in future pregnancies. We conducted a longitudinal retrospective cohort study of 2 182 365 deliveries in Quebec, Canada, between 1989 and 2016. The main exposure was maternal prepregnancy surgery. The main outcome measure was neonatal abstinence syndrome in offspring. We adjusted associations for maternal comorbidity and pregnancy characteristics using log-binomial regression models. The prevalence of neonatal abstinence syndrome in the cohort was 10.7 per 10 000 births. Compared with no surgery, prepregnancy surgery was associated with a risk ratio (RR) of neonatal abstinence syndrome of 1.63 (95% confidence interval [CI] 1.49-1.78). Risk was greater for 3 or more prepregnancy surgeries (RR 2.34, 95% CI 2.07-2.63) and age < 15 years at first surgery (1 surgery: RR 2.08, 95% CI 1.71-2.54; 2 or more surgeries: RR 2.79, 95% CI 2.32-3.37). Nearly all surgical specialties increased the risk of neonatal abstinence syndrome, but associations were strongest for cardiothoracic surgery (RR 4.45, 95% CI 2.87-6.91), neurosurgery (RR 3.00, 95% CI 1.56-5.77) and urologic surgery (RR 3.03, 95% CI 2.16-4.26). Prepregnancy surgery is associated with the risk of neonatal abstinence syndrome in future pregnancies. Prescription opioids for postsurgical pain may result in opioid use disorders during future pregnancies, inadvertently increasing the risk of neonatal abstinence syndrome in offspring.

Factors associated with the prevalence of neonatal abstinence syndrome in West Virginia.

Neonatal abstinence syndrome (NAS) is a group of problems associated with withdrawal symptoms of a newborn who was exposed to maternal opiate use while in the womb. West Virginia (WV) is of utmost concern as this state exhibits among the highest rates of opioid abuse and consequently, NAS. In this manuscript, we review factors associated with the prevalence of NAS in WV. We provide evidence suggesting that states exhibiting high Medicaid participation demonstrate a high NAS rate, further associating these two factors. Although a similar trend was observed in the substate geographic regions of WV, the presence of regional treatment facilities was negatively associated with NAS prevalence in WV, possibly suggesting that the establishment and utilization of more of these facilities may reduce NAS. Future research investigating factors that contribute to NAS is essential for the elimination of this syndrome.

Correlation of Neonatal Abstinence Syndrome With Risk of Birth Defects and Infant Morbidity

Infants with neonatal abstinence syndrome have significant morbidity, but the association with birth defects is poorly understood. This study aimed to determine how neonatal abstinence syndrome is related to birth defects, including the joint impact of neonatal abstinence syndrome and birth defects on infant morbidity. A population-based cohort of 1,944,804 neonates born in the hospitals of Quebec, Canada (1989-2013), was compiled with data on maternal exposures and infant outcomes after delivery. The prevalence of neonatal abstinence syndrome and birth defects was estimated, including the association with neonatal morbidity and mortality after adjustment for maternal age, parity, morbidity, socioeconomic deprivation, and time period. Joint effects of neonatal abstinence syndrome and birth defects on infant outcomes were assessed. Infants with neonatal abtinence syndrome had a higher prevalence of birth defects (705.7 per 10,000) than infants with no drug exposure (568.9 per 10,000). Compared with no exposure, infants with neonatal abstinence syndrome had 1.35 times the chance of having birth defects (95% confidence interval [1.14, 1.59]). Associations were strongest for central nervous system defects (risk ratio = 6.06, 95% confidence interval [3.93, 9.35]). Neonatal abstinence syndrome combined with birth defects was associated with significantly more infant morbidity and mortality. Infants with neonatal abstinence syndrome have a greater prevalence of birth defects, particularly defects of the central nervous system. Neonatal abstinence syndrome with birth defects may be an underappreciated contributor to infant morbidity.

Neonatal abstinence syndrome: where are we, and where do we go from here?

Over the last 15 years the prevalence of neonatal abstinence syndrome (NAS) increased almost five-fold. A considerable diversity seems to prevail in the management of NAS. This review provides an overview of factors affecting the expression and course of NAS, and recent developments in NAS assessment and treatment. Apart from different pharmacological and nonpharmacological treatment modalities, maturity of the infant and genetic variations likely are (co)responsible for interpatient variability in NAS severity, despite similar maternal exposure. Recent efforts concerning the further development of NAS severity scoring systems focus on the development of brief screening measures; in addition, pupil diameter and skin conductance have been proposed as complements to observer-rated scales. The decrease in incidence of NAS begins in the appropriate management of medication assisted treatment of the mother. Mitigating the negative outcomes for infants affected by NAS, their mothers and the healthcare system implies, first and foremost, developing and implementing an organized protocol for the management of NAS, and the homogenous use of a standardized scoring system utilizing interobserver reliability and a guide for medication initiation, maintenance, and weaning which is consistent with traditional methods of treatment for neonates.

Trends of Neonatal Abstinence Syndrome Epidemic and Maternal Risk Factors in Florida.

This study aimed to examine secular trends of (i) maternal prescription opioid use in late pregnancy, (ii) neonatal abstinence syndrome (NAS) stratified by late maternal prescription opioid use, and (iii) maternal risk factors among NAS deliveries. Women with a live birth who were enrolled 90 days before and 30 days after delivery in Florida Medicaid Analytic Extract billing records linked to birth certificates from 2000 to 2010 were identified for the study. Changes in the annual prevalence of prescription opioid use during pregnancy were tested with use of the Cochran-Armitage trend test. Temporal trends of NAS deliveries were estimated with the use of Poisson regression and stratified by prescription opioid exposure in the last 90 days of pregnancy in the study period. To identify contributors to the increase in NAS cases, variations in prevalence of opioid dispensing, tobacco use, antidepressant use, and substance use disorder among NAS and non-NAS deliveries were examined. There were 41,968 (9.4%) deliveries exposed to at least one opioid prescription in late pregnancy, and this rate remained stable from 2000 to 2010. Among prescription opioid-exposed deliveries, frequency of NAS increased from 1.6 to 25.2 per 1000 live births during the study period (p<0.05). Although the prevalence of maternal use of prescription opioid, tobacco, and antidepressants remained stable among NAS deliveries from 2000 to 2010, the prevalence of substance use disorder diagnoses increased substantially from 38.9% in 2000 to 67.9% in 2006 (p<0.05). The prevalence of NAS increased dramatically whereas the prevalence of major risk factors, including maternal prescription opioid use, remained stable in Florida between 2000 and 2010. The increase in substance use disorder may be responsible for the sharp increase in NAS deliveries.

A core outcome set for neonatal abstinence syndrome: study protocol for a systematic review, parent interviews and a Delphi survey.

BackgroundThe prevalence of neonatal abstinence syndrome (NAS) is increasing globally resulting in an increased incidence of adverse neonatal outcomes and health system costs. Evidence regarding the effectiveness of NAS prevention and management strategies is very weak and further research initiatives are critically needed to support meta-analysis and clinical practice guidelines. In NAS research, the choice of outcomes and the use of valid, responsive and feasible measurement instruments are crucial. There is currently no consensus and evidence-based core outcome set (COS) for NAS.Methods/designThe development of the NAS-COS will include five stages led by an international Multidisciplinary Steering Committee: (1) qualitative interviews with parents/families and a systematic review (SR) to identify items for inclusion in a COS. The SR will also identify participants for the Delphi survey, (2) a three-round Delphi survey to gain expert opinion on the importance of health outcomes influencing NAS management decisions, (3), a consensus meeting to finalize the items and definitions with experts and COS users, (4) feasibility and pilot testing, development of the COS and explanatory document and (5) implementation planning.DiscussionSince standardized outcome measurement and reporting will improve NAS clinical research consistency, efficacy and impact, this COS will reflect the minimum set of health outcomes which should be measured in trials evaluating interventions for preventing or treating NAS.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1666-9) contains supplementary material, which is available to authorized users.

Frequency of Newborn Behaviours Associated with Neonatal Abstinence Syndrome: A Hospital-Based Study

Objectives: To determine the frequency of neonatal abstinence syndrome (NAS) among unselected term newborns, using newborn behaviour data only.Methods: This hospital-based prospective exploratory study used clinical observations of newborn behaviours, mothers’ observations of their newborns and newborn chart data to determine the prevalence of suspected and confirmed cases of NAS in a convenience sample of unselected term newborns “rooming in” with their mothers in a large central city acutecare referral hospital. Over a 4-month period, 824 out of 1008 newborns were observed at between 8 and 30 hours of life by specially trained nurse observers. Behaviours recorded and their weighting were adapted from the Neonatal Abstinence Scoring System (NASS) by Finnegan and Kaltenbach. Newborns with scores of 5 or greater and “suspect for NAS” were referred to their physicians for confirmation or refutation of the clinical findings. The prevalence of “suspect for NAS” and confirmed NAS as well as of individual neonatal behaviours, was calculated.Results: Thirty-one (3.8%) of 824 term “rooming in” newborns were identified with findings suggestive of NAS. Four newborns were positively identified as having NAS and treated. The identification was confirmed by post hoc affirmation of maternal drug use. Individual behaviours occurring in 10% or more of newborns included excessive sneezing, nasal stuffiness, unsustained suck tremor, and abnormal nipple latch.Conclusions: Clinical observation of newborn behaviour may identify NAS. Further studies are recommended to correlate this methodology with laboratory findings, as are more in-depth maternal questionnaires concerning use of mood-altering substances. The Prevalence of NAS is likely underestimated because of early hospital discharge. A coordinated system of early identification and infant-specific assessment and treatment, both in hospital and following discharge home is advocated.