Effect of Low Lactose Formula on the Short-Term Outcomes of Neonatal Abstinence Syndrome: A Systematic Review

The use of low lactose formula (LLF) in term and near-term infants in infants with neonatal abstinence syndrome (NAS) has been increasing recently. However, the clinical evidence of such use is limited. Our aim in this paper was to systematically review the current literature about the use of LLF in infants with NAS. We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews for articles published between 2015 and 2020. Only randomized controlled trials, prospective, and retrospective studies. The risk of bias was assessed by using published tools appropriate for the study type. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Forty-one titles and/or abstracts were screened independently by 2 reviewers (MA and GA). After an indepth review, 4 studies answered the study question (1 randomized controlled trial (RCT), 2 retrospective studies, and 1 quality improvement study). A meta-analysis could not be completed due to the study type difference and how the outcomes were reported. The studies found no benefit to feeding LLF to infants with NAS regarding short-term outcomes (length of stay, duration, and need for pharmacological therapy and growth). Certainty in the evidence is low. In conclusion we found no beneficial effects regarding the need for pharmacological therapy, duration of pharmacological treatment, length of hospital stay, and growth of using LLF compared to the standard formula in infants with NAS.

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Effects of Partially Hydrolyzed Formula on Severity and Outcomes of Neonatal Abstinence Syndrome

American Journal of Perinatology ◽

10.1055/s-0039-1692684 ◽

2019 ◽

Vol 37 (11) ◽

pp. 1177-1182 ◽

Cited By ~ 2

Author(s):

Mahdi Alsaleem ◽

Sara K. Berkelhamer ◽

Gregory E. Wilding ◽

Lorin M. Miller ◽

Anne Marie Reynolds

Keyword(s):

Hospital Stay ◽

Controlled Trial ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Short Term ◽

Term Infants ◽

Near Term ◽

Hydrolyzed Formula

Abstract Objective This study compares the effect of partially hydrolyzed formula (PHF) and standard formula (SF) on the severity and short-term outcomes of neonatal abstinence syndrome (NAS). Study Design We performed a retrospective chart review of 124 opioid-dependent mothers and their term or near-term infants. Infants were categorized according to the predominant type of formula consumed during the hospital stay. Finnegan's scale was used to assess symptoms of withdrawal. Results A total of 110 infants met our inclusion criteria. Thirty-four (31%) infants were fed predominantly PHF, 60 (54%) infants were fed SF, and 16 (15%) infants were fed maternal breast milk. There was no difference between the infants in the PHF and SF groups with respect to requirement of morphine (MSO4) therapy, maximum dose of MSO4 used, duration of MSO4 treatment or length of hospital stay after performing multivariate analyses to control for type of drug used by the mother, maternal smoking, regular prenatal care, inborn status, and maximum Finnegan score prior to MSO4 treatment. Conclusion Use of PHF failed to impact short-term outcomes in infants treated for NAS including maximum MSO4 dose, duration of MSO4 treatment, and length of hospital stay. A prospective randomized controlled trial may be indicated to confirm this finding.

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Morphine and Methadone for Neonatal Abstinence Syndrome: A Systematic Review

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.37.6.365 ◽

2018 ◽

Vol 37 (6) ◽

pp. 365-371 ◽

Cited By ~ 2

Author(s):

Lindsay Slowiczek ◽

Darren J. Hein ◽

Zara Risoldi Cochrane ◽

Philip J. Gregory

Keyword(s):

Systematic Review ◽

Adverse Effects ◽

Clinical Evidence ◽

Length Of Hospital Stay ◽

Neonatal Abstinence Syndrome ◽

Cochrane Library ◽

Abstinence Syndrome ◽

Inclusion Criteria ◽

Randomized Controlled ◽

American Academy Of Pediatrics

PurposeTo compare the effects of morphine and methadone on length of hospital stay (LOS) or treatment (LOT) and adverse effects in infants with neonatal abstinence syndrome (NAS).DesignSystematic review.SamplePubMed, Google Scholar, Cochrane library, CINAHL, IPA, American Academy of Pediatrics, and clinicaltrials.gov were systematically searched to identify randomized controlled trials (RCTs) and observational studies. comparing morphine and methadone for NAS.OutcomesLOS, LOT, adverse effects.ResultsOne RCT, two cohort studies, and two chart reviews met inclusion criteria. Each had a low risk of bias. LOS ranged from 12.08 to 36 days with morphine and 21 to 44.23 days with methadone. LOT ranged from 7.46 to 22.9 days (morphine) and 13.9 to 38.08 days (methadone). Adverse effects were not reported. Clinical evidence comparing morphine to methadone for NAS treatment is limited and conflicting. A recommendation for one over the other cannot be made based on these outcomes.

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Clonidine as an Adjunct Therapy to Opioids for Neonatal Abstinence Syndrome: A Randomized, Controlled Trial

PEDIATRICS ◽

10.1542/peds.2008-0978 ◽

2009 ◽

Vol 123 (5) ◽

pp. e849-e856 ◽

Cited By ~ 101

Author(s):

A. G. Agthe ◽

G. R. Kim ◽

K. B. Mathias ◽

C. W. Hendrix ◽

R. Chavez-Valdez ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Adjunct Therapy ◽

Randomized Controlled

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Measurement of neonatal abstinence syndrome: Evaluation of short forms

Journal of Opioid Management ◽

10.5055/jom.2016.0308 ◽

2016 ◽

Vol 12 (1) ◽

pp. 19 ◽

Cited By ~ 12

Author(s):

Hendrée E. Jones, PhD ◽

Carl Seashore, MD ◽

Elisabeth Johnson, FNP, PhD ◽

Evette Horton, PhD ◽

Kevin E. O’Grady, PhD ◽

...

Keyword(s):

Short Form ◽

Controlled Trial ◽

Secondary Analysis ◽

Neonatal Abstinence Syndrome ◽

Maternal Outcomes ◽

Abstinence Syndrome ◽

Screening Measure ◽

Short Forms ◽

Randomized Controlled ◽

Instrument Measuring

Objectives: 1) How well do the short forms previously developed from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) neonatal abstinence syndrome (NAS) scale (MNS) discriminate between neonates untreated and treated for NAS? (2) Can a short form be developed that is superior to other short forms in discriminating between the two groups?Design/participants: This secondary analysis study used data from 131 delivered neonates in the MOTHER study, a randomized controlled trial comparing neonatal and maternal outcomes in opioid-dependent pregnant women administered buprenorphine or methadone.Setting: Comprehensive care was provided at seven university hospitals.Outcome measures: A 19-item instrument measuring neonatal abstinence signs.Results: A five-item index proved superior to the previous indices (ps < 0.01) and discriminated between the treated and untreated NAS groups as well as did the MNS total score (p=0.09).Conclusions: A short form developed from the MNS shows promise as a possible screening measure.

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