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Neonatal abstinance

Sarah C Haight, Jean Y Ko, Van T Tong, Michele K Bohm, William M Callaghan
Opioid use by pregnant women represents a significant public health concern given the association of opioid exposure and adverse maternal and neonatal outcomes, including preterm labor, stillbirth, neonatal abstinence syndrome, and maternal mortality (1,2). State-level actions are critical to curbing the opioid epidemic through programs and policies to reduce use of prescription opioids and illegal opioids including heroin and illicitly manufactured fentanyl, both of which contribute to the epidemic (3). Hospital discharge data from the 1999-2014 Healthcare Cost and Utilization Project (HCUP) were analyzed to describe U...
August 10, 2018: MMWR. Morbidity and Mortality Weekly Report
Nathalie Auger, Thuy Mai Luu, Jessica Healy-Profitós, Annick Gauthier, Ernest Lo, William D Fraser
OBJECTIVE: Infants with neonatal abstinence syndrome have significant morbidity, but the association with birth defects is poorly understood. This study aimed to determine how neonatal abstinence syndrome is related to birth defects, including the joint impact of neonatal abstinence syndrome and birth defects on infant morbidity. METHOD: A population-based cohort of 1,944,804 neonates born in the hospitals of Quebec, Canada (1989-2013), was compiled with data on maternal exposures and infant outcomes after delivery...
July 2018: Journal of Studies on Alcohol and Drugs
R Rasul, M Ward, S Clews, J Falconer, J Feller, K Lui, J Oei
AIM: We determined the safety, feasibility and sustainability of an outpatient model of care for infants exposed to intra-uterine drugs. METHODS: This was a retrospective chart review of 774 drug-exposed infants born between 1998-2016 at the Royal Hospital for Women, Sydney, Australia. RESULTS: Most (86%) of the mothers used multiple drugs, including opioids (58%). More than three-quarters (78%) of the infants were born full term at a mean gestation of 38 weeks and hospitalised for a median of seven days...
July 21, 2018: Acta Paediatrica
Anne Whittaker, Amy Chandler, Sarah Cunningham-Burley, Paula Midgley, Lawrie Elliott, Sarah Cooper
BACKGROUND: Neonatal Abstinence Syndrome (NAS) is an anticipated effect of maternal drug use during pregnancy. Yet it remains a contested area of policy and practice. In this paper, we contribute to ongoing debates about the way NAS is understood and responded to, through different treatment regimes, or logics of care. Our analysis examines the role of risk and recovery discourses, and the way in which the bodies of women and babies are conceptualised within these. METHODS: Qualitative interviews with 16 parents (9 mothers, 7 fathers) and four focus groups with 27 health and social care professionals based in Scotland...
July 16, 2018: International Journal on Drug Policy
Federica Gilardi, Marc Augsburger, Aurelien Thomas
A growing number of evidence demonstrates that ancestral exposure to xenobiotics (pollutants, drugs of abuse, etc.) can perturb the physiology and behavior of descendants. Both maternal and paternal transmission of phenotype across generations has been proved, demonstrating that parental drug history may have significant implications for subsequent generations. In the last years, the burden of novel synthetic opioid (NSO) consumption, due to increased medical prescription of pain medications and to easier accessibility of these substances on illegal market, is raising new questions first in term of public health, but also about the consequences of the parental use of these drugs on future generations...
2018: Frontiers in Pharmacology
Walter Alexander
We report on sessions on immunotherapies for non-small-cell lung cancer and pancreatic cancer from AACR and on endometriosis, hypoactive sexual desire disorder, neonatal abstinence syndrome, and more from ACOG.
July 2018: P & T: a Peer-reviewed Journal for Formulary Management
Courtney Gullickson, Stefan Kuhle, Marsha Campbell-Yeo
AIM: To examine whether adding clonidine to the morphine regimen for treatment of neonatal abstinence syndrome (NAS) is associated with a shorter length of treatment compared with morphine alone. METHODS: Using a retrospective cohort design, infants with NAS resulting from opioid exposure delivered between 2006 and 2015 (n = 174) were identified using the Nova Scotia Atlee Perinatal Database (NSAPD). Maternal and infant characteristics were collected from the NSAPD...
July 4, 2018: Acta Paediatrica
Jasmin Stadler, Wolfgang Raith
Background: Little is known about active ear acupuncture points (EAP) in neonates. Previous unblinded studies by Stähler van Amerongen et al. showed that neonates have detectable active EAP, and that sick neonates could have more EAP relative to healthy neonates. EAP was investigated in an unblinded trial involving neonates with neonatal abstinence syndrome (NAS). Furthermore, a blinded, controlled observational trial was conducted to compare active EAP present in healthy neonates with EAP of sick neonates...
June 1, 2018: Medical Acupuncture
Wolfgang Raith
This article explores the possibilities of applying ear acupuncture to newborn infants. In addition to the use of needle acupuncture, there are also noninvasive applications that are preferred for patients in this particular age group. Based on the limited literature, ear acupuncture could be an effective nonpharmacologic approach for the treatment of pain in newborn infants and for addressing symptoms of neonatal abstinence syndrome. However, studies on safety, side-effects, and other indications are still lacking...
June 1, 2018: Medical Acupuncture
Jonathan M Davis, Jeffrey Shenberger, Norma Terrin, Janis L Breeze, Mark Hudak, Elisha M Wachman, Peter Marro, Erica L Oliveira, Karen Harvey-Wilkes, Adam Czynski, Barbara Engelhardt, Karen D'Apolito, Debra Bogen, Barry Lester
Importance: Although opioids are used to treat neonatal abstinence syndrome (NAS), the best pharmacologic treatment has not been established. Objective: To compare the safety and efficacy of methadone and morphine in NAS. Design, Setting, and Participants: In this randomized, double-blind, intention-to-treat trial, term infants from 8 US newborn units whose mothers received buprenorphine, methadone, or opioids for pain control during pregnancy were eligible...
June 18, 2018: JAMA Pediatrics
Jacqueline Wong, Barry Saver, James M Scanlan, Louis Paul Gianutsos, Yachana Bhakta, James Walsh, Abigail Plawman, David Sapienza, Vania Rudolf
OBJECTIVES: To measure the incidence, onset, duration, and severity of neonatal abstinence syndrome (NAS) in infants born to mothers receiving buprenorphine and to assess the association between buprenorphine dose and NAS outcomes. METHODS: We reviewed charts of all mother-infant pairs maintained on buprenorphine who delivered in our hospital from January 1, 2000 to April 1, 2016. RESULTS: In 89 infants, NAS incidence requiring morphine was 43...
June 13, 2018: Journal of Addiction Medicine
Eric S Hall, Jennifer M McAllister, Scott L Wexelblatt
The objective was to compare diagnosis rates representing developmental outcomes and medical complications between infants with intrauterine opioid exposures who did not receive pharmacologic treatment for neonatal abstinence syndrome at the time of birth and infants for whom no exposure to substances of abuse were detected. This retrospective, descriptive study included approximately 95% of Hamilton County, Ohio resident births in 2014 and 2015. Universal maternal drug test results, performed at the time of birth, were documented and linked to electronic health records representing pediatric primary and subspecialty follow-up care as well as urgent care, emergency care, and inpatient services provided by Cincinnati Children's Hospital Medical Center through 2017, when all children were at least 24 months old...
June 12, 2018: Population Health Management
Sarah Stevens, Tyler Flaugher, Kaitlynn Hughes, Carson Terwilliger, Jessica Copley, Shekher Mohan
Objective . To assess gender differences in infants diagnosed with neonatal abstinence syndrome at the Cabell Huntington Hospital in Huntington, West Virginia. Methods . This is a single-site retrospective chart review involving 97 infants born treated for neonatal abstinence syndrome at the Cabell Huntington Hospital between April and December 2015. Data were obtained from electronic medical records using a secure online survey tool designed using Qualtrics. Maternal demographics and drug screenings were collected...
2018: Global Pediatric Health
Julie Summey, Liwei Chen, Rachel Mayo, Elizabeth Charron, Jennifer A Hudson, Windsor Westbrook Sherrill, Lori Dickes
BACKGROUND: Few coordinated treatment programs address the needs of infants and families struggling with the effects of substance use. In 2003 a large Southeastern regional hospital launched the Managing Abstinence in Newborns (MAiN) program, providing multidisciplinary, coordinated, community-based care for neonatal abstinence syndrome (NAS). A hypothesis-generating study was conducted to compare the outcomes of MAiN infants to comparable NAS infants receiving traditional care from 2006 through 2014 in South Carolina...
June 2018: Joint Commission Journal on Quality and Patient Safety
Maya Balakrishnan, Gautham Suresh
No abstract text is available yet for this article.
June 2018: Joint Commission Journal on Quality and Patient Safety
Lenora Marcellus
Health care systems are challenged with issues of overdiagnosis and overtreatment. Neonatal abstinence syndrome (NAS) may be overdiagnosed with standardized assessment protocols and may be overtreated with current NICU-based models of care. Clinical approaches to caring for neonates with NAS and their families have not significantly changed for 40 years, and there is growing interest in revisiting long-standing routine practices. I used Bronfenbrenner's social ecological systems framework to organize an exploration of factors that contribute to overdiagnosis and overtreatment in the care of neonates with NAS...
July 2018: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Tara Burnette, Lindsey Chernicky, Craig V Towers
OBJECTIVE: Standardizing treatment of neonatal abstinence syndrome (NAS) is currently recommended; however, single institution prospective studies are lacking regarding the success of this approach. The study objective was to evaluate overall newborn response and length of stay (LOS) of neonates treated for NAS following the institution of a strict standardized treatment protocol. METHODS: From 1 January 2014 to 30 June 2016, a prospective cohort study was performed collecting neonatal outcomes before and after the standardization of a strict NAS morphine weaning treatment protocol...
May 14, 2018: Journal of Maternal-fetal & Neonatal Medicine
Faouzi I Maalouf, William O Cooper, James C Slaughter, Judith Dudley, Stephen W Patrick
OBJECTIVE: To determine differences in lengths of stay, length of therapy, emergency department (ED) utilization, and hospital readmissions between infants with neonatal abstinence syndrome (NAS) treated exclusively with inpatient pharmacotherapy compared with those discharged on outpatient pharmacotherapy. STUDY DESIGN: This retrospective cohort study of infants enrolled in the Tennessee Medicaid program used administrative and vital records data from 2009 to 2011...
August 2018: Journal of Pediatrics
Amanda J Johnson, Cresta W Jones
Opioid use disorder presents an increased risk of complications in pregnancy, particularly when untreated. To optimize outcomes, medication-assisted treatment using methadone or buprenorphine as a part of a comprehensive care model is recommended. Neonatal abstinence syndrome and poor fetal growth remain significant complications of this disorder despite maternal treatment.
June 2018: Obstetrics and Gynecology Clinics of North America
Danae Bixler, Greg Corby-Lee, Scott Proescholdbell, Tina Ramirez, Michael E Kilkenny, Matt LaRocco, Robert Childs, Michael R Brumage, Angela D Settle, Eyasu H Teshale, Alice Asher
The Appalachian region of the United States is experiencing a large increase in hepatitis C virus (HCV) infections related to injection drug use (IDU) (1). Syringe services programs (SSPs) providing sufficient access to safe injection equipment can reduce hepatitis C transmission by 56%; combined SSPs and medication-assisted treatment can reduce transmission by 74% (2). However, access to SSPs has been limited in the United States, especially in rural areas and southern and midwestern states (3). This report describes the expansion of SSPs in Kentucky, North Carolina, and West Virginia during 2013-August 1, 2017...
May 11, 2018: MMWR. Morbidity and Mortality Weekly Report
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