scholarly journals Neonatal Abstinence Syndrome Due to Opioid Abuse in Pregnancy

2018 ◽  
Vol 24 (3) ◽  
pp. 170
Author(s):  
Banu Mutlu Ozyurt ◽  
Ozge Surmeli Onay ◽  
Ozlem Ersoy
Keyword(s):  
Neonatal Intensive Care ◽  
Newborn Infants ◽  
Clinical Signs ◽  
Opioid Abuse ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Childbearing Age ◽  
The Past ◽  
Abuse During Pregnancy ◽  
In Pregnancy

<p>Opioid abuse during pregnancy is increasing in women of childbearing age in Turkey. The frequency of clinical signs of withdrawal in infants who exposed to heroin in utero are varying between 16-90%. Here, we present five newborn infants presenting with neonatal abstinence syndrome who were hospitalized in Neonatal Intensive Care Unit of Mersin Maternity and Children’s Hospital. All of the five infants were symptomatic including irritability, tremors, high-pitched cry, excessive sucking and seizure. Hyperirritability was the predominant sign. Seizure was observed two of the five infants which clinically presented between 1st-5th day of life and was controlled with phenobarbital. We have experienced seizure due to withdrawal of opioid more than the past reports and we thought that interrupting breastfeeding may facilitate seizure. Breastfeeding may slow down the decrease of opioid level in blood and may reduce the symptoms. In conclusion, opioid abuse in pregnancy is a growing sociological problem in Turkey and a protocol for management is required for neonatologists.</p>

scholarly journals Maternal Opioid Abuse and Neonatal Abstinence Syndrome in the United States

2020 ◽  
Vol 5 (4) ◽  
pp. p78
Author(s):  
Elizabeth Armstrong-Mensah ◽  
Deja Woolcock ◽  
Christi Lee ◽  
Morelia Torres Diaz
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Abuse ◽  
Neonatal Abstinence Syndrome ◽  
Opioid Overdose ◽  
Abstinence Syndrome ◽  
Opioid Use ◽  
The Past ◽  
Number Of Factors ◽  
Abuse During Pregnancy

In the past decade, the United States has experienced an increase in deaths related to nonmedical and medical opioid overdose. This is due to a number of factors including an increase in recreational opioid use, and the over prescription of opioids for various conditions such as during pregnancy, injury, and illness. The over utilization of opioids during pregnancy in the United States has led to an increase in adverse neonatal birth outcomes including poor fetal growth, preterm birth, stillbirth, neonatal abstinence syndrome in neonates, and an increase in maternal mortality among mothers. These are dire consequences that should not be ignored. This paper discusses opioid abuse during pregnancy and its effects on neonates in the United States. It also discusses some challenges associated with the diagnosis of neonatal abstinence syndrome and provides recommendations for addressing the issue Additionally, it discusses what mothers can do to prevent neonatal abstinence syndrome.

scholarly journals Severe Brief Resolved Unexplained Event in a Newborn Infant in Association with Maternal Sertralin Treatment during Pregnancy

Medicines ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. 113
Author(s):  
Mirjam Pocivalnik ◽  
Manfred Danda ◽  
Berndt Urlesberger ◽  
Wolfgang Raith
Keyword(s):  
Drug Therapy ◽  
Newborn Infant ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Newborn Infants ◽  
Male Infant ◽  
Serotonin Reuptake Inhibitors ◽  
Neonatal Abstinence Syndrome ◽  
Selective Serotonin ◽  
Abstinence Syndrome

Background: Selective serotonin reuptake inhibitors are a very common choice of antidepressive drug-therapy during pregnancy. In up to 30% of cases, they have been found to cause neonatal abstinence syndrome in newborn infants. Although often both time-limiting and self-limiting, severe symptoms of neonatal abstinence syndrome (NAS) can occur. Methods/Results: We report a term male infant suffering from a severe brief resolved unexplained event caused by his mother’s sertraline intake during pregnancy. Conclusions: Newborn infants exposed to selective serotonine reuptake inhibitors (SSRIs) during pregnancy should be evaluated very carefully concerning NAS and monitored for NAS symptoms for a minimum of 72–96 h, or until symptoms have fully recovered using standardized protocols. There is a risk of severe NAS symptoms which might occur, and this circumstance should be discussed with the parents and taken into account before administering the drug.

scholarly journals Evaluation of the Cardiovascular Effects of Clonidine in Neonates Treated for Neonatal Abstinence Syndrome

2018 ◽  
Vol 23 (6) ◽  
pp. 473-478
Author(s):  
Raymond P. Meddock ◽  
Deirdre Bloemer
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Neonatal Intensive Care ◽  
Dose Range ◽  
Safety Data ◽  
Cardiovascular Effects ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome

OBJECTIVES Neonatal abstinence syndrome (NAS) is characterized by withdrawal symptoms in neonates exposed to legal or illegal substances in utero, and it is often managed with medications such as opiates, phenobarbital, and clonidine. Clonidine use is increasing, but further safety data regarding its use in neonates are warranted. This study evaluated the effects of clonidine on heart rate and blood pressure in neonates treated for NAS at doses up to 24 mcg/kg/day. METHODS A retrospective review via the electronic medical record of infants at least 35 weeks' gestation treated adjunctively with clonidine for NAS in the neonatal intensive care unit at St Elizabeth was conducted. Heart rate, and systolic and diastolic blood pressure were recorded at baseline, while on different dose ranges of clonidine (small: ≤1.5 mcg/kg per dose every 3 hours; medium: &gt;1.5 to 2 mcg/kg per dose every 3 hours; and large: &gt;2 mcg/kg to 3 mcg/kg per dose every 3 hours), and upon discontinuation. RESULTS A total of 64 infants treated with clonidine for NAS between August 2015 and December 2016 were included. Heart rate decreased in all clonidine dose ranges compared with baseline (average reduction of 7 bpm [CI: −12 to −2], 9 bpm [CI: −16 to −2], and 10 bpm [CI: −18 to −1] for the small, medium, and large dose ranges, respectively; p &lt; 0.0001). Systolic and diastolic blood pressure were not significantly different from baseline when infants were receiving any dose of clonidine, except diastolic blood pressure while on medium–dose range clonidine, where diastolic blood pressure was higher than baseline (p = 0.0128). Increases in systolic and diastolic blood pressure were evident upon discontinuation of clonidine (p &lt; 0.0001 and p = 0.0156, respectively). CONCLUSIONS Clonidine doses up to 24 mcg/kg/day are well tolerated in neonates ≥35 weeks' gestation treated for NAS. Any decreases in heart rate are likely clinically insignificant, and increases in blood pressure upon discontinuing clonidine are mild and may be mitigated further with extended discontinuation protocols. Further trials should be conducted to evaluate the long-term safety of clonidine in this population.

20 Years of Follow-up Alloimmunization and Hemolytic Disease in Newborn: Has Anything Changed in the Field Over the Years?

2020 ◽  
Vol 232 (06) ◽  
pp. 314-320
Author(s):  
Marjana Jerkovic Raguz ◽  
Zeljka Prce ◽  
Vedran Bjelanovic ◽  
Ivana Bjelanovic ◽  
Sanja Dzida ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Preventive Measures ◽  
Newborn Infants ◽  
Significant Progress ◽  
Hemolytic Disease ◽  
The West ◽  
The Past ◽  
Precautionary Measures ◽  
In Pregnancy

Abstract Objective of the study is to research the epidemiological aspects of maternal alloimmunization against erythrocyte antigens of fetuses (AB0, Rhesus, Lewis, Kell, Duffy and others) and to identify the most common types of hemolytic disease of the newborn (HDN) in the West Herzegovina region. Study Design The 20-year retrospective epidemiological study includes all pregnant women who had been immunologically tested and newborn treated for HDN. Results The indirect antiglobulin (IAT) detected antibodies against antigens in 545 (1.8%) pregnant women of the 29 663 who were tested at the Department of Transfusion Medicine. During the 20-year-long study 310 (1.0%) newborn with HDN were treated. Our results indicate that 42% (230/545) of the pregnant women had AB0 immunization. The most common form of HDN is AB0 HDN 64% (199/310), whereas RhD HDN was treated in 19% (59/310) of the newborn infants. ETR was performed on 29 (19%) infants, 21 (72.4%) with AB0 HDN, and 7 (26%) with RhD HDN. Conclusion This 20-year-long study concludes that, even though there has been significant progress in the prevention of immunization and proactive treatment of HDN, precautionary measures are still required as is the need for gynecologists and obstetricians to be active. The reasons for this are the non-existence of preventive measures for non-RhD immunization, the irregular immunological screening of RhD positive women in pregnancy in the region encompassed by the study in the past few years. The above raises new questions and recommends further research and monitoring of immunization and HDN treatment worldwide.

scholarly journals Project Console: a quality improvement initiative for neonatal abstinence syndrome in a children’s hospital level IV neonatal intensive care unit

2021 ◽  
Vol 10 (2) ◽  
pp. e001079
Author(s):  
Kathryn L Ponder ◽  
Charles Egesdal ◽  
Joanne Kuller ◽  
Priscilla Joe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Neonatal Abstinence Syndrome ◽  
Quality Improvement Initiative ◽  
Abstinence Syndrome ◽  
Post Intervention ◽  
High Acuity

ObjectiveTo improve care for infants with neonatal abstinence syndrome.DesignInfants with a gestational age of ≥35 weeks with prenatal opioid exposure were eligible for our quality improvement initiative. Interventions in our Plan–Do–Study–Act cycles included physician consensus, re-emphasis on non-pharmacological treatment, the Eat Sleep Console method to measure functional impairment, morphine as needed, clonidine and alternative soothing methods for parental unavailability (volunteer cuddlers and automated sleeper beds). Pre-intervention and post-intervention outcomes were compared.ResultsLength of stay decreased from 31.8 to 10.5 days (p<0.0001) without an increase in readmissions. Composite pharmacotherapy exposure days decreased from 28.7 to 5.5 (p<0.0001). This included reductions in both morphine exposure days (p<0.0001) and clonidine exposure days (p=0.01). Fewer infants required pharmacotherapy (p=0.02).ConclusionsOur study demonstrates how a comprehensive initiative can improve care for infants with neonatal abstinence syndrome in an open-bay or a high-acuity neonatal intensive care unit when rooming-in is not available or other comorbidities are present.

scholarly journals Methadone for Treatment of Pregnant Opiate Addicted Women: Is There a Safer Alternative? A Review of Literature

2008 ◽  
Author(s):  
Holly Tichelkamp ◽  
Thomas Parish
Keyword(s):  
Neonatal Intensive Care ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Review Of Literature ◽  
Methadone Dose ◽  
Intrauterine Growth ◽  
Opiate Use ◽  
Hospital Stays ◽  
Opiate Addicts ◽  
Alternative Medications

Methadone is commonly used for the treatment of pregnant opiate-addicts. But, it can have severe effects on the neonate including Neonatal Abstinence Syndrome, increased length of stay in the neonatal intensive care unit, and intrauterine growth retardation. Neonatal Abstinence Syndrome includes neurological excitability, gastrointestinal dysfunction, and autonomic signs. Because of these adverse effects, studies have been conducted to determine what can help reduce the severe complications caused by methadone. Varied dosages of methadone and alternative medications, such as buprenorphine, slow-release morphine, and others have been studied. Most of the alternative medications, especially buprenorphine, are gaining popularity in Europe where there is a growing problem of opiate use during pregnancy. In the studies comparing methadone and buprenorphine, a slight decline in symptoms of Neonatal Abstinence Syndrome as well as shorter hospital stays for the neonates exposed to buprenorphine was noted. Studies of different dosages of methadone were conducted to determine the lowest methadone dose that is both effective for the mother and safe for the neonate. All of the studies have provided information that is helping in the search for the safest and most effective treatment for opiate addiction. What is known is that helping the mother overcome the addiction is very important. So far, the data collected are not strong enough to make a conclusion on the best choice for treatment. Further research is indicated for methadone itself and also for all its possible alternatives.

Nurses' Finnegan Scoring of Newborns with Neonatal Abstinence Syndrome Not Affected by Time or Day of the Week

2019 ◽  
Vol 37 (02) ◽  
pp. 224-230 ◽  
Author(s):  
Alla Kushnir ◽  
Jennifer L. Bleznak ◽  
Judy G. Saslow ◽  
Gary Stahl
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Time Of Day ◽  
Behavioral Changes ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Institutional Review ◽  
Day Of The Week ◽  
Scoring Tool

Abstract Objective Newborns exposed to drugs in utero are at risk of developing neonatal abstinence syndrome (NAS), characterized by behavioral changes and physiologic instability. Finnegan scoring tool quantifies severity of symptoms and guides treatment. This article evaluates whether time of day and the number of shift hours affects modified Finnegan scores, and the subjective component of these scores. Study Design Institutional review board-approved, retrospective chart review of newborns admitted to neonatal intensive care or transitional nursery from 2011 to 2014. Inclusion criteria: > 35 weeks' gestation, known maternal substance use, positive maternal or newborn urine, or meconium drug screen, NAS treatment. Results A total of 101 charts were evaluated. Mean treatment duration was 31.8 days (standard deviation ±18.3). There was no significant relationship between observer shift hour and high scores (> 8) (p = 0.83). Highest scores occurred in the afternoon, decreased at night (p = 0.03), and throughout admission (p < 0.0001). Weekend and weekday scores were similar (p = 0.4). The objective component of the scores remained similar throughout the day (p = 0.91) and week (p = 0.52). Conclusion Finnegan scores given by nurses were not influenced by shift hour. Time of day did not influence overall high scores or the proportion of objective to total Finnegan score. Inter-rater reliability was maintained regardless of time of day or day of the week.

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