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The opioid-exposed newborn: Assessment and pharmacologic management

Lauren M. Jansson, MD, Martha Velez, MD, Cheryl Harrow, RNC-LRN, MS, FNP-BC, IBCLC, RLC

Abstract


The infant exposed to opioids in utero frequently presents a challenge to the neonatal care provider in the assessment and treatment of symptoms of Neonatal Abstinence Syndrome (NAS) after birth. This review is intended to provide the healthcare professional with a brief review of current evidence and practical guidelines for optimal evaluation and pharmacologic management of the opioid-exposed newborn.

Keywords


neonatal abstinencesyndrome, methadone, opioids, infant, substance abuse

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References


National Institutes on Drug Abuse, National Pregnancy and Health Survey: Drug use during pregnancy. NIDA Notes 2005; Jan/Feb.

Collins G, McAllister M: Combating abuse and diversion of prescription opiate medications. Psychiatric Annals [Online]. 2006; 36: 410-416.

US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Emergency Department Trends form the Drug Abuse Warning Network, Final Estimates 1995-2002, 2003.

US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Treatment Episode Data Set (TEDS), 2003, 2003.

Gottheil E, Sterling R, Weinstein S: Diminished illicit drug use as a consequence of long-term methadone maintenance. J Addict Dis. 1993; 12: 45-57.

Lowinson J, Marion I, Joseph H, et al.: Methadone maintenance. In Lowinson J, Ruiz P (eds.): Substance Abuse: Clinical Problems and Perspectives. Baltimore, MD: Williams and Wilkins, 1981: 550-561.

Kreek M: Medical complications in methadone patients. Ann N Y Acad Sci. 1978; 311: 110-134.

Kakko J, Heilig M, Sarman I: Buprenorphine and methadone treatment of opiate dependence during pregnancy: Comparison of fetal growth and neonatal outcomes in two consecutive case series. Drug Alcohol Depend. 2008; 96: 69-78.

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: 677-685.

McCarthy JJ, Leamon MH, Stenson G, et al.: Outcomes of neonates conceived on methadone maintenance therapy. J Subst Abuse Treat. 2008; 35(2): 202-206.

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

Desmond MM, Wilson GS: Neonatal abstinence syndrome: Recognition and diagnosis. Addict Dis. 1975; 2: 113-121.

Finnegan L: Treatment issues for opioid-dependent women during the perinatal period. J Psychoactive Drugs. 1991; 23: 191-201.

Velez M, Jansson LM: Non-pharmacologic care of the opioid dependent mother and her newborn. J Addict Med. 2008; 2(3): 113-120.

Finnegan L, Kaltenbach K: Neonatal abstinence syndrome. In Hoekelman R, Friedman S, Nelson N, et al. (eds.): Primary Pediatric Care. St Louis, MO: Mosby-Year Book, 1992: 1367-1378.

Doberczak T, Kandall S, Wilets I: Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr. 1991; 118: 933-937.

Finnegan L, Connaughton J, Kron R, et al.: Neonatal abstinence syndrome: Assessment and management. Addict Dis. 1975; 2: 141-158.

The American Academy of Pediatrics, Committee on Drugs: Neonatal drug withdrawal. Pediatrics. 1998; 101: 1079-1088.

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

Ostrea EM: Infants of drug-dependent mothers. In Burg FD, Ingelfinger JR, Wald R (eds.): Current Pediatric Therapy, 14th ed. Philadelphia, PA: WB Saunders, 1993: 800-801.

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

Sarkar S, Donn S: Management of neonatal abstinence syndrome in neonatal intensive care units: A national survey. J Perinatol. 2006; 26: 15-17.

Colombini N, Elias R, Busuttil M, et al.: Hospital morphine preparation for abstinence syndrome in newborns exposed to buprenorphine or methadone. Pharm World Sci. 2008; 30(3): 227-234.

Ebner N, Rohrmeister K, Winklbaur B, et al.: Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Drug Alcohol Depend. 2007; 87(2-3): 131-138.

Berde CB, Sethna NF, Holzman RS, et al.: Pharmacokinetics of methadone in children and adolescents in the perioperative period [abstr]. Anesthesiology. 1987; 67: A519.

Theis JGW, Selby P, Ikizler Y, et al.: Current management of the neonatal abstinence syndrome: A critical analysis of the evidence. Biol Neonate. 1997; 71: 345-356.

Johnson K, Gerada C, Greenough A: Treatment of neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed. 2005; 88: F2-F5.

Osborn DA, Cole MJ, Jeffrey HE. Opiate Treatment for Opiate Withdrawal in Newborn Infants (Review). Chichester: John Wiley & Sons, 2005.

Lagenfeld S, Birkenfeld L, Herkenrath P, et al.: Therapy of the neonatal abstinence syndrome with tincture of opium or morphine drops. Drug Alcohol Depend. 2005; 77: 31-36.

Lainwala S, Brown ER, Weinschenk NP, et al.: A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care. 2005; 5(5): 265-272.

Coyle MG, Ferguson A, Lagasse L, et al.: Diluted tincture of opium (DTO) and phenobarbital versus DTO alone for neonatal opiate withdrawal in term infants. J Pediatr. 2002; 140: 561-564.

Kraft WK, Gibson E, Dysart K, et al.: Sublingual buprenorphine for treatment of neonatal abstinence syndrome: A randomized trial. Pediatrics. 2008; 122(3): e601-e607.

Hoder EL, Leckman JF, Poulsen J, et al.: Clonidine treatment of neonatal narcotic abstinence syndrome. Psychiatry Res. 1984; 13: 243-251.

Agthe A, Mathias KB, Hendrix CW, et al.: Clonidine in combination with diluted tincture of opium (DTO) versus TO alone for opioid withdrawal in newborn infants: A blinded randomized clinical trial. Abstract presented at the Society for Pediatric Research Meeting, May 2007.

Jansson LM, Svikis D, Lee J, et al.: Pregnancy and addiction: A comprehensive care model. J Subst Abuse Treat. 1996; 13: 321-329.

Kandall SR, Gaines J, Habel L, et al.: Relationship of maternal substance abuse to subsequent sudden infant death syndrome in offspring. J Pediatr. 1993; 123: 120-126.

Mack G, Thomas D, Giles W, et al.: Methadone levels and neonatal withdrawal. J Paediatr Child Health 1991; 27: 96-100.

Jones HC: Shorter dosing interval of opiate solution shortens hospital stay for methadone babies. Fam Med. 1999; 31: 327-330.

Jansson LM, Elko A, DiPietro J. Fetal response to maternal methadone administration. Am J Obstet Gynecol. 2005; 193: 611-617.




DOI: https://doi.org/10.5055/jom.2009.0006

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