Signs Of Neonatal Abstinence Syndrome Research Articles

49 Rooming-In to Treat Neonatal Abstinence Syndrome

Abstract Background Ontario has been facing a steady rise in the number of individuals abusing narcotics. Newly implemented rooming-in programs in Ontario have allowed infants of opioid-dependent mothers to stay in the same room as their mother while the infant continues to be monitored for signs of neonatal abstinence syndrome (NAS). Objectives To retroactively review the impact of a rooming-in program for babies at risk of NAS on the need for pharmacologic treatment and length of stay in one community hospital site in Belleville, Ontario. Design/Methods Belleville General Hospital developed a rooming-in program for newborns at risk of NAS in July 2015. Prior to its inception, the standard of care was to admit these infants to the special care nursery for monitoring and treatment. Charts were reviewed to collect data on infants born to mothers using opioids in the 24 months prior to (July 2013 – June 2015) and after (July 2015 – June 2017) the implementation of our program. The two groups were compared for the primary outcomes studied, including the number of babies started on morphine and length of stay in hospital. Secondary outcomes were also examined, including breast feeding rates, resource intensity weight, and total hospital cost. Results Rooming-in is associated with a reduction in the need for treatment with morphine, shorter length of stay in hospital, improved breast feeding rates, and lower total hospital cost. Conclusion Our study demonstrates that rooming-in programs for babies born to mothers using opioids have benefits in terms of quality of care and health care resource utilization. These findings add to the existing literature on NAS that rooming-in can be successfully implemented in a community hospital.

Evaluation and analysis of the Modified Finnegan Scoring System for assessment of neonatal abstinence syndrome.

The Finnegan Neonatal Abstinence Scoring System (FNASS) is the most commonly used scoring system for neonatal abstinence syndrome (NAS) both in its original and modified versions, despite challenges related to tool length and observer bias. The purpose of this study was to determine the most frequent symptoms of NAS that led to score elevation and prompted initiation of drug therapy on the Modified Finnegan (MF). We also sought to identify vital sign changes associated with score elevation. We conducted a retrospective study of neonates diagnosed with NAS, based on ICD-9 codes and charge data for methadone administration. The study setting was in a Level III Neonatal Intensive Care Unit. Ninety patients with a total of 286 MF scores recorded from 2011 to 2015 met inclusion criteria. The primary outcome was overall occurrence for each specific component of the MF scoring tool during symptomatic periods. Secondary outcomes were vital sign changes. Among the MF elements, there were 13 components that were scored more often than others in symptomatic infants. Respiratory rate (RR) was elevated in infants with NAS, but other vital signs did not differ from age-specific norms. Of the various signs of NAS used to score the MF, few are frequently observed. Our study reinforces literature that proposes a shortened MF assessment tool. Experimental research will be needed to determine the efficacy of a shortened MF tool for diagnosing NAS.

Association of a Simplified Finnegan Neonatal Abstinence Scoring Tool With the Need for Pharmacologic Treatment for Neonatal Abstinence Syndrome

Observer-rated scales, such as the Finnegan Neonatal Abstinence Scoring Tool (FNAST), are used to quantify the severity of neonatal abstinence syndrome (NAS) and guide pharmacologic therapy. The FNAST, a comprehensive 21-item assessment tool, was developed for research and subsequently integrated into clinical practice; a simpler tool, designed to account for clinically meaningful outcomes, is urgently needed to standardize assessment. To identify FNAST items independently associated with the decision to use pharmacologic therapy and to simplify the FNAST while minimizing loss of information for the treatment decision. This multisite cohort study included 424 neonates with opioid exposure who had a gestational age of at least 36 weeks with follow-up from birth to hospital discharge in the derivation cohort and 109 neonates with opioid exposure from the Maternal Opioid Treatment: Human Experimental Research Study in the validation cohort. Neonates in the derivation cohort were included in a medical record review at the Universities of Louisville and Kentucky or in a randomized clinical trial and observational study conducted at Tufts University (2014-2018); the Maternal Opioid Treatment: Human Experimental Research was conducted from 2005 to 2008. Data analysis was conducted from May 2017 to August 2019. Prenatal opioid exposure. All FNAST items were dichotomized as present or not present, and logistic regression was used to identify binary items independently associated with pharmacologic treatment. The final model was validated with an independent cohort of neonates with opioid exposure. Among 424 neonates (gestational age, ≥36 weeks; 217 [51%] female infants), convulsions were not observed, and high-pitched cry and hyperactive Moro reflex had extremely different frequencies across cohorts. Therefore, these 3 FNAST items were removed from further analysis. The 2 tremor items were combined, and 8 of the remaining 17 items were independently associated with pharmacologic treatment, with an area under the curve of 0.86 (95% CI, 0.82-0.89) compared with 0.90 (95% CI, 0.87-0.94) for the 21-item FNAST. External validation of the 8 items resulted in an area under the curve of 0.86 (95% CI, 0.79-0.93). Thresholds of 4 and 5 on the simplified scale yielded the closest agreement with FNAST thresholds of 8 and 12 (weighted κ = 0.55; 95% CI, 0.48-0.61). The findings of this study suggest that 8 signs of NAS may be sufficient to assess whether a neonate meets criteria for pharmacologic therapy. A focus on these signs could simplify the FNAST tool and may enhance its clinical utility.

Comparison of Safety and Efficacy of Methadone vs Morphine for Treatment of Neonatal Abstinence Syndrome

Although opioids are used to treat neonatal abstinence syndrome (NAS), the best pharmacologic treatment has not been established. To compare the safety and efficacy of methadone and morphine in NAS. In this randomized, double-blind, intention-to-treat trial, term infants from 8 US newborn units whose mothers received buprenorphine, methadone, or opioids for pain control during pregnancy were eligible. A total of 117 infants were randomized to receive methadone or morphine from February 9, 2014, to March 6, 2017. Mothers who declined randomization could consent to data collection and standard institutional treatment. Infants were assessed with the Finnegan Neonatal Abstinence Scoring System every 4 hours and treated with methadone or placebo every 4 hours or morphine every 4 hours. Infants with persistently elevated Finnegan scores received dose increases. Infants who exceeded a predetermined opioid dose received phenobarbital. Dose reductions occurred every 12 to 48 hours when signs of NAS were controlled with therapy, stopping at 20% of the original dose. The primary end point was length of hospital stay (LOS). The secondary end points were LOS attributable to NAS and length of drug treatment (LOT). A total of 183 mothers consented to have their infants in the study; 117 infants required treatment. Because 1 parent withdrew consent, data were analyzed on 116 infants (mean [SD] gestational age, 39.1 [1.1] weeks; mean [SD] birth weight, 3157 [486] g; 58 [50%] male). Demographic variables and risk factors were similar except for more prenatal cigarette exposure in infants who received methadone. Adjusting for study site and maternal opioid type, methadone was associated with decreased mean number of days for LOS by 14% (relative number of days, 0.86; 95% CI, 0.74-1.00; P = .046), corresponding to a difference of 2.9 days; 14% reduction in LOS attributable to NAS (relative number of days, 0.86; 95% CI, 0.77-0.96; P = .01), corresponding to a difference of 2.7 days; and 16% reduction in LOT (relative number of days, 0.84; 95% CI, 0.73-0.97; P = .02), corresponding to a difference of 2.3 days. Methadone was also associated with reduced median LOS (16 vs 20 days, P = .005), LOS attributable to NAS (16 vs 19 days, P = .005), and LOT (11.5 vs 15 days, P = .009). Study infants had better short-term outcomes than 170 nonrandomized infants treated with morphine per standard institutional protocols. With use of weight- and sign-based treatment for NAS, short-term outcomes were better in infants receiving methadone compared with morphine. Assessment of longer-term outcomes is ongoing. ClinicalTrials.gov Identifier: NCT01958476.

Is there Failure to Screen for Hepatitis C in Newborns Suffering from Neonatal Abstinence Syndrome?

BackgroundEnormous advances in treating/curing patients suffering from Hepatitis C (HepC) infection have occurred; resulting in many states mandating screening for HepC for older individuals. Unfortunately, no protection of screening exists for newborns. In Kentucky, rates of HepC among pregnant women are the second highest within the U.S., which has been associated to high intravenous drug use. Infants born to those women are at risk of HepC infection and other conditions such as neonatal abstinence syndrome (NAS). The current study examined the rate of HepC screening in a high-risk cohort (newborns suffering from NAS) and it’s impact on policy-making for this vulnerable population.MethodsKentucky Medicaid records, from 2015, were obtained to develop a detailed demographic, behavioral, clinical, and diagnostic data set (n = 152,749). NAS was defined by ICD-9 code 779.5 and ICD-10 code P96.1. HepC screening was defined by CPT codes (CPT 87520 [HCV, direct probe], 87521 [HCV, amplified probe], and 87522 [HCV RNA, Quantitative] or antibody [CPTs 86803–4]). Initially a descriptive study was performed, then multiple logistic regression techniques were used to test what variables impacted the odds of not being screened for HepC.ResultsA total of 1234 newborns with NAS were identified. The majority showed signs of NAS within 24 hours (64%), were white (68%) and were admitted to the hospital for an average of 24.8 days. Only one-in-three newborns with NAS (n = 412, 33.4%) were screened for HepC. Non-Whites (OR = 1.58, 95% CI 1.45–1.71, P < 0.001) and those living in non-urban areas (OR = 1.42, 95% CI 1.28–1.56, P < 0.001) were the only study variables to significantly impact the odds of not being screened for HepC (for newborns suffering from NAS).ConclusionA high-risk and vulnerable population for HepC may not be getting screened for HepC and thus are being underserved by the health care system. Non-Whites and those in rural areas are the most affected. Solutions and policies need to be focused on this population and area where screening is lacking. Optimization of maternal screening for HepC is crucial in high-risk populations.Disclosures All authors: No reported disclosures.

Improving Care for Neonates With Abstinence Syndrome

Research Article| September 01 2017 Improving Care for Neonates With Abstinence Syndrome AAP Grand Rounds (2017) 38 (3): 28. https://doi.org/10.1542/gr.38-3-28 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Improving Care for Neonates With Abstinence Syndrome. AAP Grand Rounds September 2017; 38 (3): 28. https://doi.org/10.1542/gr.38-3-28 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: morphine, neonatal abstinence syndrome, opioids, patient readmission, seizures, transfer technique, sleep, neonatal intensive care units, inpatients Source: Grossman MR, Berkwitt AK, Osborn RR, et al. An initiative to improve the quality of care of infants with neonatal abstinence syndrome. Pediatrics. 2017; 39(6): e20163360; doi: https://doi.org/10.1542/peds.2016-3360Google Scholar Investigators from Yale University conducted a study to assess the effectiveness of an initiative designed to decrease length of stay (LOS) in newborns treated for neonatal abstinence syndrome (NAS) at Yale New Haven Children’s Hospital (YNHCH). In the pre-intervention period of 2008–2010, newborns at risk for NAS were admitted to the NICU. Signs of NAS were assessed by using the Finnegan Neonatal Abstinence Scoring System (FNASS). On the basis of FNASS scores, oral morphine was administered every 3 hours; morphine doses were decreased by ≤10% every 24–48 hours, if possible. Over a 5-year period, a multidisciplinary team developed interventions designed to reduce LOS in newborns with NAS. Interventions were assessed by using plan-do-study-act methodology. Ultimately, the initiative focused on several interventions, including maximizing the use of nonpharmacological interventions, effectively engaging parents in the care of their children, discontinuing the use of FNASS and instead developing a simplified assessment of newborn symptoms, decreasing the use of morphine, and admitting newborns with NAS to inpatient units that allowed parents to room in. With the revised assessment system, neonates who could breastfeed effectively or take ≥1 oz from a bottle, sleep for ≥1 hour, and, if crying, be consoled within 10 minutes were not given morphine. Morphine (0.05 mg/kg) was administered on an as-needed basis to newborns not meeting these criteria. To assess the effectiveness of the initiative, outcomes in neonates treated for NAS at YNHCH during the pre-intervention period and those treated for NAS after the interventions were implemented (May 2015 to June 2016) were compared. Outcomes evaluated included LOS, need for morphine treatment, and hospital costs. Balancing measures assessed were need for transfer to a NICU, seizures, and hospital readmission. Data on 55 newborns born during the baseline period and 44 in the postimplementation period were analyzed. Mean LOS was 22.4 days for those treated in the baseline period and 5.9 days in the postimplementation period (74% reduction, P < .001). The percentage of neonates requiring morphine treatment decreased from 98% to 14% between the pre- and postimplementation periods (P <.001), and mean hospital costs decreased from $44,824 to $10,289 (P < .001). There were no seizures reported in any patient and no readmissions, and no newborn admitted to an inpatient unit required transfer to a NICU. The authors conclude that the initiative to improve care for newborns with NAS led to a substantial reduction in LOS. Dr Winer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Although this was a relatively small, single-site study, it demonstrates a remarkable quality-improvement measure for multiple reasons. It represents a new approach to an old problem, that of NAS—the constellation of neuromuscular and gastrointestinal... You do not currently have access to this content.

Management of Neonatal Abstinence Syndrome

Research Article| September 01 2017 Management of Neonatal Abstinence Syndrome AAP Grand Rounds (2017) 38 (3): 27. https://doi.org/10.1542/gr.38-3-27 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Management of Neonatal Abstinence Syndrome. AAP Grand Rounds September 2017; 38 (3): 27. https://doi.org/10.1542/gr.38-3-27 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: buprenorphine, morphine, neonatal abstinence syndrome, length of stay Source: Kraft WK, Adeniyi-Jones SC, Chervoneva I, et al. Buprenorphine for the treatment of the neonatal abstinence syndrome. N Engl J Med. 2017; 376(24): 2341– 2348; doi: https://doi.org/10.1056/NEJMoa1614835Google Scholar Investigators from Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and Icahn School of Medicine at Mount Sinai, New York City, conducted a randomized, double-blind, placebo-controlled trial to compare the effectiveness and safety of oral morphine and sublingual buprenorphine for the treatment of neonatal abstinence syndrome (NAS). Full-term newborns (≥37 weeks’ gestation) who had been exposed to opioids in utero and had signs of NAS were enrolled in the study and were randomized to receive either morphine every 4 hours or buprenorphine every 8 hours; all study neonates also received placebo resembling the active medications to maintain blinding. Randomization was stratified by the mother’s intention to breastfeed. Criteria for initiating, weaning, and discontinuing the study drug were based on scores on the Maternal Opioid Treatment: Human Experimental Research, or MOTHER, NAS scale—a modified Finnegan scoring instrument. Phenobarbital was added if maximum doses of buprenorphine (60 μg/kg/d) or morphine (1.2 mg/kg/d) were reached in a newborn. The primary study outcome was duration of drug treatment for NAS. Secondary outcomes included length of hospital stay and need for supplemental phenobarbital. Safety measures included changes in weight from birth and respiratory rate, as well as adverse events. Outcomes were compared in newborns assigned to the morphine or buprenorphine treatment groups. Data were analyzed in 63 neonates, including 33 who received buprenorphine and 30 who were randomized to morphine. Median duration of treatment was 15 days for those in the buprenorphine group and 28 days for those randomized to morphine (P < .001). Length of hospital stay was also significantly shorter for neonates receiving buprenorphine than for those in the morphine group (median of 21 days and 33 days, respectively; P < .001). Five newborns (15%) in the buprenorphine group required supplemental phenobarbital, versus 7 (23%) of those randomized to the morphine group (P = .36). There were no significant differences in rates of adverse events. The respiratory rates of neonates assigned to receive morphine were lower than those of neonates in the buprenorphine group (P =. 02), although all respiratory rates were in the normal range. At 7 days, the reduction in weight from birth was significantly greater in those receiving buprenorphine, but there were no significant differences in change from birth weight among newborns in the 2 treatment groups at days 14, 21, and 28. The authors conclude that the use of buprenorphine to treat NAS in neonates resulted in shorter lengths of treatment and hospital stay than treatment with morphine. Dr Mintzer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Opioid withdrawal after in utero exposure causes a constellation of signs and symptoms, including irritability, tremors, poor feeding, and loose stools.... You do not currently have access to this content.

Abuse of antiretroviral drugs, combined with addictive drugs by pregnant women is associated with adverse effects in infants and risk of resistance

Reports of the use of antiretroviral drugs (ARVs) to produce a highly addictive drug called nyaope or whoonga are of major concern as ARVs are easily accessible in sub ­ Saharan Africa, including to pregnant women. Use of illicit drugs by pregnant women may result in serious adverse effects in their infants. We have noticed a sudden increase in the number of infants presenting with signs suggestive of neonatal abstinence in Chris Hani Baragwanath Academic Hospital. Here we report two neonates who were born to mothers addicted to nyaope. Both infants were growth restricted and presented with signs of neonatal abstinence syndrome that are likely due to nyaope or whoonga. We suggest that in growth ­ restricted infants born to mothers who are at high risk of substance abuse and/or are receiving ARVs, screening for substance abuse should be considered.

A Case-Control Study on Perinatal Outcomes of Opium-Addicted Pregnant Women and Their Offsprings in Rafsanjan, Iran

Background: Substance abuse during pregnancy leads to considerable adverse effects in mothers and their infants. Objectives: The purpose of this study was to evaluate perinatal complications in opium-addicted mothers and their newborns, exposed to opium in utero. Patients and Methods: During a one-year period (2008 - 2009), 45 opium-addicted mothers and their newborns were enrolled in a case-control study in Niknafs maternity hospital, Iran. Maternal drug usage was determined via self-reporting during structured interviews. Neonates with in-utero opium exposure were assessed and treated for neonatal abstinence syndrome (NAS). Demographic characteristics and perinatal complications for case and control subjects were obtained from medical records. Results: All cases were addicted to inhaled opium and none received methadone therapy. None of the cases was a heavy cigarette smoker, consumed alcohol, or had positive serology result for sexually-transmitted diseases. The mean ages were similar in both case and control groups. There was a higher prevalence of opium addiction among spouses of the case group subjects compared with the control group (P = 0.001). The case group had significantly lower education level (P = 0.01) and socioeconomic status (P = 0.001) compared to the control group. Low birth weight (LBW) was more frequent in the opium-exposed neonates compared with the control group neonates (P = 0.001). In the opium-exposed infants, signs of NAS were found in 32 (71%), requiring pharmacotherapy in 25 (55%) cases. Conclusions: Opium addiction among Iranian pregnant women is associated with an increased frequency of LBW in newborns. Furthermore, approximately half of the newborns exposed to opium in utero require pharmacotherapy for NAS. These findings support the need for comprehensive multidisciplinary evidence-based interventions in at-risk population.

Safe Use of Opioid Analgesics for Chronic Pain in Pregnancy

Poster Presentation Objective To identify safe practices for management of chronic pain in pregnancy. Design Retrospective chart review. We studied three commonly used opioid analgesics, compared neonatal outcomes for each of the agents, and identified potential contributing factors to the incidence of neonatal abstinence syndrome (NAS). Sample Neonatal outcomes were evaluated for all singletons delivered full term during a 42‐month period, whose mothers met inclusion criteria and were taking codeine, hydrocodone, or oxycodone at any dosage three or more times per week. Methods The first phase was the retrospective chart review. Charts for every patient delivered by the perinatology practice for the specified time frame were individually reviewed for appropriateness for the study. Data were manually gathered onto an individual data sheet and de‐identified. Once all charts were reviewed and data collected, data were coded and entered into a spreadsheet and analyzed for trends in neonatal outcomes using descriptive statistics. The second phase was to use the information collected combined with available data from other studies to create practice guidelines. Implementation Strategies Outcomes examined included gestational age at delivery, birth weight, APGAR score, admission to the neonatal intensive care unit (NICU), diagnosis of NAS, length of stay, and treatment required. Maternal demographics were evaluated for any potential impact on neonatal outcome trends. Results Thirty‐one charts met criteria for the study. Nine neonates required a NICU admission. Length of NICU stay ranged from 2 to 10 days with an average NICU stay of 5 days. Two neonates required medical management with methadone. They were the only two with a diagnosis of NAS. Six of the nine were admitted for transient tachypnea of the newborn (TTN) and one was diagnosed as a poor feeder. Baseline data indicated that there is no association between NICU stay and agent used or between specific dosages or use of more than one agent. The study was limited by small sample size and multiple potential contributing factors to observed neonatal outcomes. Conclusion/Implications for Nursing Practice Obstetric and neonatal nurse and practitioners must become knowledgeable about the use of opioid analgesics in pregnancy. The findings of this study indicate the need for further research but support the judicious use of opioid analgesics at minimum effective doses. Thorough evaluation of the neonate at delivery for signs of NAS and TTN is warranted, and supportive care in a NICU environment can ease the transition to extrauterine life without opioid exposure.

Differences in the profile of neonatal abstinence syndrome signs in methadone‐ versus buprenorphine‐exposed neonates

To compare the profile of signs of neonatal abstinence syndrome (NAS) in methadone- versus buprenorphine-exposed infants. Secondary analysis of NAS data from a multi-site, double-blind, double-dummy, flexible-dosing, randomized clinical trial. Data from a total of 129 neonates born to opioid-dependent women who had been assigned to receive methadone or buprenorphine treatment during pregnancy were examined. For 10 days after delivery, neonates (methadone = 72, buprenorphine = 57) were assessed regularly using a 19-item modified Finnegan scale. Data from neonates who required pharmacological treatment (methadone = 41, buprenorphine = 27) were included up to the time treatment was initiated. The incidence and mean severity of the total NAS score and each individual sign of NAS were calculated and compared between medication conditions, as was the median time until morphine treatment initiation among treated infants in each condition. Two NAS signs (undisturbed tremors and hyperactive Moro reflex) were observed significantly more frequently in methadone-exposed neonates and three (nasal stuffiness, sneezing, loose stools) were observed more frequently in buprenorphine-exposed neonates. Mean severity scores on the total NAS score and five individual signs (disturbed and undisturbed tremors, hyperactive Moro reflex, excessive irritability, failure to thrive) were significantly higher among methadone-exposed neonates, while sneezing was higher among buprenorphine-exposed neonates. Among treated neonates, methadone-exposed infants required treatment significantly earlier than buprenorphine-exposed infants (36 versus 59 hours postnatal, respectively). The profile of neonatal abstinence syndrome differs in methadone- versus buprenorphine-exposed neonates, with significant differences in incidence, severity and treatment initiation time. Overall, methadone-exposed neonates have a more severe neonatal abstinence syndrome.

Neonatal abstinence syndrome (NAS) after intrauterine exposure to tramadol

Sir, Neonatal abstinence syndrome (NAS) may occur after in utero exposure to a wide spectrum of pharmacological substances w5x. Most commonly, it is related to infants born to drug abusing mothers. In contrast, NAS may also occur in the context of legitimately prescribed maternal medication, and even when taken in recommended doses. The clinical presentation of NAS is variable, however, infants typically present with a combination of neurological, gastrointestinal and respiratory symptoms and the most commonly used assessment tool for the detection and severity scoring of NAS is the Finnegan score w10x. We present a rare case of NAS after maternal treatment with tramadol, prescribed during pregnancy for pain relief after scoliosis operations. A 23-year-old primigravida gave birth to a term female newborn by cesarean section (gestational age 38q0; birth weight 3.1 kg; Apgar scores 8, 8 and 9 at 1, 5 and 10 min; umbilical cord pH 7.27). Pregnancy was uneventful except for chronic medication of tramadol (300 mg/day) due to chronic back pain. After regular postnatal adaptation, first signs of NAS occurred on day 2 of life. Symptoms included increased irritability, tachycardia and vomiting. Laboratory investigations including blood sugar levels were normal. The clinical evaluation using the Finnegan score had maximum values of 17 points on day 3 of life and treatment with oral

Managing drug withdrawal in the newborn infant

The management of the infant exposed to drugs in utero poses significant challenges. Symptoms and signs of neonatal abstinence syndrome (NAS) are non-specific but most commonly associated with withdrawal from maternal opioids. A high index of suspicion is required when presented with an infant who could be manifesting symptoms of NAS. In the absence of a reliable history of maternal drug exposure, analysis of neonatal meconium or urine may be indicated. Approximately 90% of infants exposed to opioids will exhibit signs of NAS, although a smaller proportion will require pharmacological treatment. Although few studies have evaluated the advantages of different therapeutic agents and strategies, opioid withdrawal is best treated initially with opioid medication. Supportive care of the infant should include assessment of the adequacy of feeding, evaluation of social circumstances (particularly child protection issues) and surveillance for transmission of viral infection.

Opioid Detoxification in Pregnancy

In Brief Objective Opioid withdrawal has been associated with poor fetal growth, preterm delivery, and fetal death. We sought to evaluate the safety of antepartum opioid detoxification in selected gravidas. Methods Between 1990 and 1996, women with singleton gestations who reported opioid use were offered inpatient detoxification. Predetoxification sonography was performed to confirm gestational age and to exclude fetuses with growth restriction and oligohydramnios. Women with mild withdrawal symptoms were given clonidine initially, and methadone was substituted if symptoms persisted. Objective signs of withdrawal were treated with methadone from the outset. Antenatal testing was performed once gestations reached 24 weeks. Newborns were observed for signs of neonatal abstinence syndrome and were treated as necessary. Obstetric and neonatal outcome data were collected. Results Thirty-four gravidas elected to undergo opioid detoxification at a mean gestational age of 24 weeks. The median maximum dose of methadone was 20 mg per day (range 10–85 mg), and the median time to detoxification was 12 days (range 3–39 days). Overall, 20 women (59%) successfully underwent detoxification and did not relapse, ten (29%) resumed antenatal opioid use, and four (12%) did not complete detoxification and opted for methadone maintenance. There was no evidence of fetal distress during detoxification, no fetal death, and no delivery before 36 weeks. Fifteen percent of neonates were treated for narcotic withdrawal. Conclusion In selected patients, opioid detoxification can be accomplished safely during pregnancy. Selected gravidas can undergo antepartum opioid detoxification safely.

Opioid detoxification in pregnancy

Objective: Opioid withdrawal has been associated with poor fetal growth, preterm delivery, and fetal death. We sought to evaluate the safety of antepartum opioid detoxification in selected gravidas. Methods: Between 1990 and 1996, women with singleton gestations who reported opioid use were offered inpatient detoxification. Predetoxification sonography was performed to confirm gestational age and to exclude fetuses with growth restriction and oligohydramnios. Women with mild withdrawal symptoms were given clonidine initially, and methadone was substituted if symptoms persisted. Objective signs of withdrawal were treated with methadone from the outset. Antenatal testing was performed once gestations reached 24 weeks. Newborns were observed for signs of neonatal abstinence syndrome and were treated as necessary. Obstetric and neonatal outcome data were collected. Results: Thirty-four gravidas elected to undergo opioid detoxification at a mean gestational age of 24 weeks. The median maximum dose of methadone was 20 mg per day (range 10–85 mg), and the median time to detoxification was 12 days (range 3–39 days). Overall, 20 women (59%) successfully underwent detoxification and did not relapse, ten (29%) resumed antenatal opioid use, and four (12%) did not complete detoxification and opted for methadone maintenance. There was no evidence of fetal distress during detoxification, no fetal death, and no delivery before 36 weeks. Fifteen percent of neonates were treated for narcotic withdrawal. Conclusion: In selected patients, opioid detoxification can be accomplished safely during pregnancy.