Neonatal abstinence scores in opioid-exposed and nonexposed neonates: A blinded comparison

Hendrée E. Jones, PhD; Cheryl Harrow, RN-LRN, MS, FNP-BC, IBCLC; Kevin E. O’Grady, PhD; Michael Crocetti, MD; Lauren M. Jansson, MD; Karol Kaltenbach, PhD

doi:10.5055/jom.2010.0038

Authors

Hendrée E. Jones, PhD
Cheryl Harrow, RN-LRN, MS, FNP-BC, IBCLC
Kevin E. O’Grady, PhD
Michael Crocetti, MD
Lauren M. Jansson, MD
Karol Kaltenbach, PhD

DOI:

https://doi.org/10.5055/jom.2010.0038

Keywords:

neonate, methadone, substance abuse, pregnancy, women

Abstract

Twenty-nine opioid-exposed and 26 nonopioid-exposed neonates received neonatal abstinence syndrome (NAS) assessment by an examiner blinded to group status twice daily over the first two postnatal days. The opioid-exposed group had higher mean NAS scores than the nonopioid-exposed group. A 3-sign index, consisting of hyperactive moro reflex, mild tremors when undisturbed, and increased muscle tone, showed excellent discrimination between groups. The use of a 3-sign screening index in the days immediately after birth may provide a cost-effective mechanism for the identification of opioid-exposed infants, particularly in infants of women for whom identification of status as a substance user may not be immediately evident. Although a potentially useful screening tool, the 3-sign screening tool should not replace the full assessment of the opioid-exposed infant after birth.

Author Biographies

Hendrée E. Jones, PhD

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Cheryl Harrow, RN-LRN, MS, FNP-BC, IBCLC

Department of Neonatology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.

Kevin E. O’Grady, PhD

Department of Psychology, University of Maryland, College Park, College Park, Maryland.

Michael Crocetti, MD

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Lauren M. Jansson, MD

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Karol Kaltenbach, PhD

Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania.

References

Substance Abuse and Mental Health Services Administration. Office of Applied Studies: Results from the 2007 national survey on drug use and health: National findings, Rep. No. NSDUH Series H-34, DHHS Publication No SMA 08-4343. 2008.

Kaltenbach K, Finnegan LP: Methadone maintenance during pregnancy: Implications for perinatal and developmental outcome. In Sonderegger T (ed.): Perinatal Substance Abuse: Research Findings and Clinical Implications. Baltimore MD: John Hopkins University Press, 1990: 239-253.

Connaughton JF Jr, Finnegan LP, Schut J, et al.: Current concepts in the management of the pregnant opiate addict. Addict Dis. 1975; 2(1-2): 21-35.

Blinick G, Wallach RC, Jerez E: Pregnancy in narcotics addicts treated by medical withdrawal. The methadone detoxification program. Am J Obstet Gynecol. 1969; 105(7): 997-1003.

Kandall SR, Gartner LM: Late presentation of drug withdrawal symptoms in newborns. Am J Dis Child. 1974; 127(1): 58-61.

Zahorodny W, Rom C, Whitney W, et al.: The neonatal withdrawal inventory: A simplified score of newborn withdrawal. J Behav Pediatr. 1998; 19(2): 89-93.

Green M, Suffet F: The neonatal narcotic withdrawal index: A device for the improvement of care in the abstinence syndrome. Am J Drug Alcohol Abuse. 1981; 8(2): 203-213.

Lipsitz PJ: A proposed narcotic withdrawal score for use with newborn infants: A pragmatic evaluation of its efficacy. Clin Pediatr. 1975; 14(6): 592-594.

Finnegan LP, Kaltenbach K: Neonatal abstinence syndrome. In Hoekelman RA, Friedman SB, Nelson NM, et al. (eds.): Primary Pediatric Care. 2nd ed. St. Louis: Mosby, 1992: 1367-1378.

O’Grady MJ, Hopewell J, White MJ: Management of neonatal abstinence syndrome: A national survey and review of practice. Arch Dis Child Fetal Neonatal Ed. 2009; 94(4): F249-F252.

Jansson LM, Velez M, Harrow C: The opioid-exposed newborn: Assessment and pharmacologic management. J Opioid Manag. 2009; 5(1): 47-55.

Jones HE, Johnson RE, Jasinski DR, et al.: Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: Effects on the neonatal abstinence syndrome. Drug Alcohol Depend. 2005; 79(1): 1-10.

Choo RE, Huestis MA, Schroeder JR, et al.: Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure. Drug Alcohol Depend. 2004; 75(3): 253-260.

Fischer G, Ortner R, Rohrmeister K, et al.: Methadone versus buprenorphine in pregnant addicts: A double-blind, double-dummy comparison study. Addiction. 2006; 101(2): 275-281.

Winklbaur B, Baewert A, Jagsch R, et al.: Association between prenatal tobacco exposure and outcome of neonates born to opioid-maintained mothers. Implications for treatment. Eur Addict Res. 2009; 15(3): 150-156.

Jansson LM, DiPietro JA, Elko A, et al.: Maternal vagal tone change in response to methadone is associated with neonatal abstinence syndrome severity in exposed neonates. J Matern Fetal Neonatal Med. 2007; 20(9): 677-685.

Jansson LM, DiPietro JA, Elko A, et al.: Infant autonomic functioning and neonatal abstinence syndrome. Drug Alcohol Depend. 2010; 109(1-3): 198-204.

Jansson LM, Velez ML: Infants of drug-dependent mothers. Pediatr Rev. (in press).

Franck LS, Harris SK, Soetenga DJ, et al.: The Withdrawal Assessment Tool-Version 1 (WAT-1): An assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008; 9(6): 573-580.