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Neonatal abstinance

Fábio Martins, David Oppolzer, Catarina Santos, Mário Barroso, Eugenia Gallardo
Opiate use during pregnancy has been an increasing problem over the last two decades, making it an important social and health concern. The use of such substances may have serious negative outcomes in the newborn, and clinical and cognitive conditions have been reported, including neonatal abstinence syndrome, developmental problems, and lower cognitive performance. These conditions are common when opiates are used during pregnancy, making the prescription of these kinds of drugs problematic. Moreover, the mother may develop opiate addiction, thus, increasing the likelihood of the infant being born with any of those conditions...
February 16, 2019: Toxics
Matthew Grossman, Adam Berkwitt
Neonates exposed prenatally to opioids will often develop a collection of withdrawal signs known as neonatal abstinence syndrome (NAS). The incidence of NAS has substantially increased in recent years placing an increasing burden on the healthcare system. Traditional approaches to assessment and management have relied on symptom-based scoring tools and utilization of slowly decreasing doses of medication, though newer models of care focused on non-pharmacologic interventions and rooming-in have demonstrated promise in reducing length of hospital stay and medication usage...
January 15, 2019: Seminars in Perinatology
A K Mangat, G M Schmölzer, W K Kraft
Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of >8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means...
February 5, 2019: Seminars in Fetal & Neonatal Medicine
Karol Kaltenbach
This paper reviews the history of the development of scoring tools used to assess the occurrence and severity of the Neonatal Abstinence Syndrome. Beginning with the first tools published in 1975, this review describes tools published through 2010; identifies each tool's strengths and weaknesses; and discusses their representation in the literature.
February 4, 2019: Seminars in Fetal & Neonatal Medicine
Summon Chomchai, Jariya Phuditshinnapatra, Pattaraporn Mekavuthikul, Chulathida Chomchai
Recreational drug toxicity is a rapidly evolving aspect in clinical practice. The prevalence of recreational drug abuse in the past decade has achieved an epidemic scale due to invention of new agents and ease of accessibility to the abused drugs. "Unconventional recreational drugs" is the term that includes new psychoactive drugs and medications diverted for recreational goals. Misuse of unconventional recreational drugs during pregnancy can affect both the pregnant woman and the fetus. However, the problems are usually unrecognized and overlooked by healthcare professionals...
February 4, 2019: Seminars in Fetal & Neonatal Medicine
Davida M Schiff, Matthew R Grossman
Infants with in-utero opioid exposure are most commonly assessed using the Finnegan Neonatal Abstinence Scoring System (FNASS) or a modified version of that tool. Traditionally, the purpose of these tools has been to characterize the extent of withdrawal signs to guide the pharmacologic treatment for infants with neonatal opioid withdrawal syndrome (NOWS). In the past decade however, in response to some of the limitations of the FNASS tool, there has been an increasing emphasis on developing novel assessment tools not based on the FNASS in addition to the promotion of non-pharmacologic treatment options as the first line treatment for infants with opioid exposure...
January 28, 2019: Seminars in Fetal & Neonatal Medicine
Jamie Limjoco, Lucyna Zawadzki, Meghan Belden, Jens Eickhoff, Chrysanthy Ikonomidou
OBJECTIVE: Though central nervous system irritability is a well-established consequence of neonatal drug withdrawal, brain function in infants with neonatal abstinence syndrome (NAS) is not well understood. Amplitude-integrated electroencephalography (aEEG) is a bedside tool used for monitoring brain activity and seizures. We describe the prevalence of abnormal aEEG background patterns in infants with NAS. METHODS: In this pilot, observational study, primary outcomes were aEEG findings, Finnegan scores and length of hospital stay in NAS patients...
February 5, 2019: Journal of Maternal-fetal & Neonatal Medicine
Emily W Rosenthal, Jason K Baxter
Pregnancy presents a window of opportunity for effecting positive change in the lives of women with opioid use disorder (OUD). Care should be empathetic and nonjudgmental with a focus on counseling for initiation and maintenance of beneficial health behaviors as well as development of a strong patient-provider relationship.1 These include adherence to treatment of OUD through pharmacotherapy and behavioral counseling, smoking cessation, healthy nutrition, treatment of coexisting medical and psychosocial conditions, as well as preparation for the postpartum period through breastfeeding education and antenatal discussion of contraception...
January 14, 2019: Seminars in Perinatology
Elisha M Wachman, Lindsay A Farrer
Neonatal abstinence syndrome (NAS) due to in-utero opioid exposure is a growing epidemic with significant variability in clinical presentation and severity. Currently, NAS severity cannot be predicted based on clinical factors alone. To date, small studies have identified genetic variants in opioid receptor and stress response genes that are associated with differences in NAS pharmacologic treatment rates and length of hospitalization. In addition, epigenetic variation in the mu opioid receptor (OPRM1) gene has been associated with differences in NAS hospitalization outcomes...
January 25, 2019: Seminars in Fetal & Neonatal Medicine
Raymond P Meddock, Deirdre Bloemer
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...
November 2018: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Stephen W Patrick, Laura J Faherty, Andrew W Dick, Theresa A Scott, Judith Dudley, Bradley D Stein
Importance: Neonatal abstinence syndrome (NAS) has increased over the last 2 decades, but limited data exist on its association with economic conditions or clinician supply. Objective: To determine the association among long-term unemployment, clinician supply (as assessed by primary care and mental health clinician shortage areas), and rates of NAS and evaluate how associations differ based on rurality. Design, Setting, and Participants: Ecological time-series analysis of a retrospective, repeated cross-sectional study using outcome data from all 580 counties in Florida, Kentucky, Massachusetts, Michigan, New York, North Carolina, Tennessee, and Washington from 2009 to 2015 and economic data from 2000 to 2015...
January 29, 2019: JAMA: the Journal of the American Medical Association
Elisha M Wachman, Martha M Werler
No abstract text is available yet for this article.
January 22, 2019: JAMA Pediatrics
Timothy Disher, Courtney Gullickson, Balpreet Singh, Chris Cameron, Leah Boulos, Louis Beaubien, Marsha Campbell-Yeo
Importance: Incidence of neonatal abstinence syndrome is rising rapidly, and optimal pharmacotherapy may meaningfully reduce length of treatment. Objective: To compare pharmacological therapies for neonatal abstinence syndrome. Data Sources: Systematic review and network meta-analysis of Medline (1946-June 2018), Embase (1974-June 2018), Cochrane CENTRAL (1966-June 2018), Web of Science (1900-June 2018), and (June 2018)...
January 22, 2019: JAMA Pediatrics
Margaret Holmes, Mary Ellen Wright
BACKGROUND: Perinatal substance exposure is an increasing concern in infants being cared for in neonatal intensive care units. Current recommendations support nonpharmacologic treatments for this population of infants. Multimodal (motion, sound) seats are often employed to soothe infants. PURPOSE: The purpose of this study was to survey neonatal intensive care unit nurses on their practices regarding the use of a motion/sound infant seat. METHODS: Sixty-six nurses (52% of 126 total nurses) completed the survey about their self-disclosed practices that included (1) reasons for use; (2) rationale for choice of settings of motion and sound; (3) duration of time infants spent in seat in one session; (4) perception of positive infant response; (5) who places infants in the seat; and (6) nursing instructions dispensed prior to use...
January 11, 2019: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Jean L Raphael, Shale L Wong
No abstract text is available yet for this article.
January 12, 2019: Pediatric Research
Florence Thibaut, Abdeslam Chagraoui, Leslie Buckley, Florence Gressier, Javier Labad, Sandrine Lamy, Marc N Potenza, Marta Rondon, Anita Rossler, Michael Soyka, Kim Yonkers
OBJECTIVES: These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS: We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication...
January 11, 2019: World Journal of Biological Psychiatry
Shahla M Jilani, Meghan T Frey, Dawn Pepin, Tracey Jewell, Melissa Jordan, Angela M Miller, Meagan Robinson, Tomi St Mars, Michael Bryan, Jean Y Ko, Elizabeth C Ailes, Russell F McCord, Julie Gilchrist, Sarah Foster, Jennifer N Lind, Lindsay Culp, Matthew S Penn, Jennita Reefhuis
From 2004 to 2014, the incidence of neonatal abstinence syndrome (NAS) in the United States increased 433%, from 1.5 to 8.0 per 1,000 hospital births. The latest national data from 2014 indicate that one baby was born with signs of NAS every 15 minutes in the United States (1). NAS is a drug withdrawal syndrome that most commonly occurs among infants after in utero exposure to opioids, although other substances have also been associated with NAS. Prenatal opioid exposure has also been associated with poor fetal growth, preterm birth, stillbirth, and possible specific birth defects (2-5)...
January 11, 2019: MMWR. Morbidity and Mortality Weekly Report
Taylor Rogerson, Anthony Houston, Garrett Lyman, Jenna Ogden, Kevin Paschall, Mark Penaranda, Alexandria Rios, Robert Wetzel, Joseph Horzempa
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...
November 2018: Journal of Opioid Management
Marc-Alexandre Duceppe, Marc M Perreault, Anne Julie Frenette, Lisa D Burry, Philippe Rico, Annie Lavoie, Céline Gélinas, Sangeeta Mehta, Maryse Dagenais, David R Williamson
WHAT IS KNOWN AND OBJECTIVE: Many critically ill patients are exposed to opioids and benzodiazepines at high doses for prolonged periods, and upon discontinuation of these drugs, they may be at risk for iatrogenic withdrawal. Although this syndrome was associated with worse outcomes in the critically ill, limited guidance exists regarding its evaluation, prevention and treatment. This systematic review examined the frequency, risk factors and symptomatology of iatrogenic withdrawal from opioids and/or benzodiazepines in critically ill neonates, children and adults...
December 19, 2018: Journal of Clinical Pharmacy and Therapeutics
Lindsay Slowiczek, Darren J Hein, Zara Risoldi Cochrane, Philip J Gregory
PURPOSE: To 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). DESIGN: Systematic review. SAMPLE: PubMed, Google Scholar, Cochrane library, CINAHL, IPA, American Academy of Pediatrics, and were systematically searched to identify randomized controlled trials (RCTs) and observational studies. comparing morphine and methadone for NAS...
November 2018: Neonatal Network: NN
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