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.

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: >1.5 to 2 mcg/kg per dose every 3 hours; and large: >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 < 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 < 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.

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.

Factors associated with the prevalence of neonatal abstinence syndrome in West Virginia

2018 ◽  
Vol 14 (6) ◽  
pp. 445-452 ◽  
Author(s):  
Taylor Rogerson, BSc ◽  
Anthony Houston II, BA ◽  
Garrett Lyman, BS ◽  
Jenna Ogden, BS ◽  
Kevin Paschall, BS ◽  
...  
Keyword(s):  
West Virginia ◽  
Neonatal Abstinence Syndrome ◽  
Future Research ◽  
Abstinence Syndrome ◽  
Factors Associated ◽  
Opiate Use ◽  
Two Factors ◽  
Treatment Facilities ◽  
Geographic Regions ◽  
Regional Treatment

Neonatal abstinence syndrome (NAS) is a group of problems associated with withdrawal symptoms of a newborn who was exposed to maternal opiate use while in the womb. West Virginia (WV) is of utmost concern as this state exhibits among the highest rates of opioid abuse and consequently, NAS. In this manuscript, we review factors associated with the prevalence of NAS in WV. We provide evidence suggesting that states exhibiting high Medicaid participation demonstrate a high NAS rate, further associating these two factors. Although a similar trend was observed in the substate geographic regions of WV, the presence of regional treatment facilities was negatively associated with NAS prevalence in WV, possibly suggesting that the establishment and utilization of more of these facilities may reduce NAS. Future research

The Incidence of Neonatal Abstinence Syndrome in Babies Born to Women with Sickle Cell Disease: A Single Center Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3225-3225
Author(s):  
Cynthia L Anderson ◽  
Karin J Blakemore ◽  
Sophie Lanzkron
Keyword(s):  
Sickle Cell Disease ◽  
Length Of Stay ◽  
Sickle Cell ◽  
Maternal Age ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Cell Disease ◽  
Live Births ◽  
Hospital Stays ◽  
The Mean

Abstract Abstract 3225 BACKGROUND: Little is known about the neonatal outcomes of infants born to mothers with SCD. Women with SCD are often treated for pain with opioid medication either intermittently or chronically throughout pregnancy. The incidence of withdrawal or neonatal abstinence syndrome has not been well described making counseling of these women about the risks and benefits of opioid therapy during pregnancy difficult. The objective of this study was to determine the incidence of neonatal abstinence syndrome (NAS) in babies born to women with sickle cell disease. METHODS: All pregnancies in women with sickle cell disease were identified within the Johns Hopkins Hospital between January 1, 2001 and January 1, 2011. Retrospective data collection was performed using the electronic medical record. Demographic and outcome information recorded included maternal age, gestational age at time of delivery, outcome of pregnancy, maternal genotype, neonatal intensive care unit (NICU) admissions, neonatal abstinence syndrome diagnosis and neonatal length of stay. Student t-tests and chi square analysis were used to compare outcomes as appropriate. RESULTS: 69 unique patients were identified. From these 69 women, 94 pregnancies were identified. Of these 94 pregnancies, 83 live births were noted. The other 11 pregnancies included 3 spontaneous abortions, 3 ectopic pregnancies, 4 terminations and 1 fetal death in utero. The mean maternal age at time of delivery was 25.5 +/− 5.1 years. The mean gestational age was 36 weeks 2 days (median 36 weeks 6 days with a range of 31 weeks 4 days to 39 weeks 3 days). Of the 83 live births noted in this retrospective cohort, 22 (27%) of these infants were admitted to the NICU and17 (20%) were diagnosed with neonatal abstinence syndrome. Of the 17 infants born with NAS, 12 infants (70%) were born to mothers with SS disease, 3 infants (18%) to mothers with Sβthalassemia and 2 infants (12%) to mothers with SC disease. 53% of babies born with NAS were delivered by C-section which was not statistically significantly different than babies born without NAS (42% p=0.60) The mean birth weight of the babies with NAS was 2521 grams compared to babies without NAS which was 2853 grams (p=0.07). 59% of babies with NAS required NICU care compared to 16% of babies without NAS (p<0.001). The mean length of stay for babies with NAS was significantly longer than those babies without NAS (14.7 days vs. 5.8 days, p=0.003). Of the babies without NAS, 44% had extended hospital stays due to baby-associated complications and the mean LOS was 10.6 days; 10% had extended hospital stays due to complications of the mother with a mean LOS of 6.5 days; and the mean LOS for the 45% of those without mother or baby complications was 2.5 days. CONCLUSIONS: Current recommendations include the use of opioids as needed for vaso-occlusive pain in pregnancies complicated by sickle cell disease. While effective, our study demonstrates that a significant percentage of infants exposed to opioids in utero develop neonatal abstinence syndrome. Future studies are indicated to delineate a dose-response relationship if one exists as well as alternative therapies to address this newly recognized important neonatal co-morbidity. Disclosures: Lanzkron: Hemaquest: Membership on an entity's Board of Directors or advisory committees; NHLBI: Research Funding.

Is Maternal Methadone Dose Associated with the Severity of Neonatal Abstinence Syndrome?

2020 ◽  
Author(s):  
Jessica Smith ◽  
Margaret Lafferty ◽  
Rupsa C. Boelig ◽  
David Carola ◽  
Susan Adeniyi-Jones ◽  
...  
Keyword(s):  
Regression Models ◽  
Pharmacological Therapy ◽  
Neonatal Abstinence Syndrome ◽  
High Dose ◽  
Abstinence Syndrome ◽  
Linear Regression Models ◽  
Methadone Dose ◽  
Morphine Dose ◽  
Duration Of Hospitalization ◽  
Multivariable Regression Models

Objective The aim of the study is to assess the correlation between maternal methadone dose and severity of neonatal abstinence syndrome (NAS) in infants that required pharmacological treatment for NAS. Study Design This is a retrospective analysis of 574 infants ≥35 weeks' gestation exposed to methadone in utero, born between August 2006 and May 2018, and who required pharmacological therapy for NAS. Indicators of NAS severity (duration of morphine treatment, maximum morphine dose, use of phenobarbital, and length of hospitalization) were compared between infants exposed to high (≥200 mg), intermediate (100–199 mg), and low doses (<100 mg) of methadone. Logistic and linear regression models were used to adjust for the covariates. Results Median (interquartile range) duration of medical treatment with morphine was higher in infants exposed to higher doses of methadone (low dose 23 [14–37] days, intermediate dose 31 [18–45] days, and high dose 35 [20–48] days, p < 0.001). Higher methadone doses were also predictive of longer duration of hospitalization, higher maximum morphine dose, and increased likelihood of treatment with phenobarbital. The association between maternal methadone dose and the severity of NAS persisted in multivariable regression models. Conclusion Infants exposed to higher methadone doses displayed more severe NAS, as indicated by longer durations of treatment, higher maximum morphine dose, longer duration of hospitalization, and increased likelihood of phenobarbital use. Key Points

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.

Methadone dose and neonatal abstinence syndrome-systematic review and meta-analysis

Addiction ◽  
2010 ◽  
Vol 105 (12) ◽  
pp. 2071-2084 ◽  
Author(s):  
Brian J. Cleary ◽  
Jean Donnelly ◽  
Judith Strawbridge ◽  
Paul J. Gallagher ◽  
Tom Fahey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Methadone Dose
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