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Neonatal abstinence syndrome

Joe Dooley, Gareth Ryan, Lianne Gerber Finn, Megan Bollinger, Cai-Lei Matsumoto, Wilma M Hopman, Len Kelly
INTRODUCTION: Opioid use in pregnancy is increasing globally. In northwest Ontario, rates of neonatal abstinence syndrome (NAS) are alarmingly high. We sought to document the increasing rates of opioid exposure during pregnancy and associated cases of NAS over a 7-year period in northwest Ontario. METHODS: We conducted a retrospective chart review at the Sioux Lookout Meno Ya Win Health Centre catchment area (population 29 000) maternity program in northwest Ontario of mother-infant dyads of live births from Jan...
2018: Canadian Journal of Rural Medicine
Enrique Gomez-Pomar, Loretta P Finnegan
Neonatal abstinence syndrome (NAS) refers to a constellation of signs that are present in some newborn infants resulting from the abrupt cessation of passive transfer of maternal opioids used during pregnancy. The classic NAS refers to infants born to mothers who used opioids during pregnancy, but the term has broadened to include infants whose mothers have used or abused other psychoactive substances during pregnancy that contribute to the expression of the syndrome. Pregnant women who use opioids do so illicitly, and/or as medically prescribed for pain relief, and/or as medication assisted treatment for opioid dependence...
2018: Frontiers in Pediatrics
Jason N Moore, Marc R Gastonguay, Chee M Ng, Susan C Adeniyi-Jones, David E Moody, Wenfang B Fang, Michelle E Ehrlich, Walter K Kraft
Neonatal abstinence syndrome (NAS) is a condition affecting newborns that are exposed to an opioid in utero. In a randomized, controlled trial assessing the efficacy of buprenorphine and morphine in NAS, blood samples were analyzed from a subset of patients receiving buprenorphine along with NAS scores. The data were used to validate and adapt an existing model of buprenorphine in neonates and to identify relationships between buprenorphine or norbuprenorphine pharmacokinetics (PK) and efficacy or safety. The time to NAS stabilization was found to decrease with increasing buprenorphine exposure...
March 8, 2018: Clinical Pharmacology and Therapeutics
Elizabeth Yen, Jonathan M Davis
Neonatal abstinence syndrome (NAS) is a constellation of withdrawal symptoms in infants born to mothers with chronic opioid use during pregnancy. A proportion of infants will need pharmacotherapy in addition to non-pharmacological interventions. In this article, we reviewed a clinical trial comparing the use of sublingual buprenorphine to oral morphine (the most widely used pharmacotherapy for NAS) in term infants. The primary end point was the duration of treatment, and secondary end points were the length of hospital stay, the proportion of infants who needed supplemental phenobarbital, and safety...
March 7, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Stephanie L Merhar, Jennifer M McAllister, Kathryn E Wedig-Stevie, Amy C Klein, Jareen Meinzen-Derr, Brenda B Poindexter
OBJECTIVE: Little is known about developmental outcomes in neonatal abstinence syndrome (NAS). We hypothesized that children treated for NAS would score lower than the normative sample on the Bayley Scales of Infant Development, 3rd edition. STUDY DESIGN: We performed a retrospective cohort study of 87 infants treated for NAS and evaluated at 2 years of age. RESULTS: Children treated for NAS scored significantly lower than the norm (mean 100) on all 3 subscales (cognitive mean 96...
March 7, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Michele C Walsh, Moira Crowley, Scott Wexelblatt, Susan Ford, Pierce Kuhnell, Heather C Kaplan, Richard McClead, Maurizio Macaluso, Carole Lannon
OBJECTIVES: Neonatal abstinence syndrome (NAS) after an infant's in-utero exposure to opioids has increased dramatically in incidence. No treatment standards exist, leading to substantial variations in practice, degree of opioid exposure, and hospital length of stay. METHODS: The Ohio Perinatal Quality Collaborative conducted an extensive multi-modal quality improvement initiative with the goal to (1) standardize identification, nonpharmacologic and pharmacologic treatment in level-2 and 3 NICUs in Ohio, (2) reduce the use of and length of treatment with opioids, and (3) reduce hospital length of stay in pharmacologically treated newborns with NAS...
March 7, 2018: Pediatrics
Amy L Haycraft
Opioid use disorder (OUD) in pregnancy is increasing, which often results in poor maternal and neonatal outcomes including neonatal abstinence syndrome (NAS) as a result of lack of prenatal care and inadequate substance use disorder management. Practice guidelines have been developed to manage OUD during and after pregnancy for mother and baby, but barriers exist, limiting comprehensive implementation. To reduce the impact of OUD in pregnancy and associated maternal and neonatal sequela, implementing compassionate evidence-based care and a non-punitive response is needed...
March 1, 2018: Journal of Psychosocial Nursing and Mental Health Services
Jacqueline Filteau, Helen Coo, Kimberly Dow
BACKGROUND: Neonatal abstinence syndrome (NAS) is a collection of symptoms that occurs primarily due to antenatal opioid exposure. National data on incidence, hospital resource utilization, and demographic features of NAS have not been previously described for Canada. METHODS: Secondary analysis was performed with data from hospitals in all Canadian provinces and territories, excluding Quebec. Infants with NAS were identified by searching for ICD-10-CA code P96...
February 13, 2018: Drug and Alcohol Dependence
Eric S Hall, Scott L Wexelblatt, James M Greenberg
The objective was to use population-based electronic health records for surveillance of intrauterine exposures to substances of abuse, including opioids, and to monitor changes in exposure rates over time. This retrospective, descriptive analysis utilized geocoded neonatal physician billing records representing intrauterine exposures to substances of abuse detected through universal maternal drug testing. Census tract-level exposure rates were identified among the newborn population of Hamilton County, Ohio between 2014 and 2016...
February 27, 2018: Population Health Management
Katie Murphy, Helen Coo, Ruth Warre, Vibhuti Shah, Kimberly Dow
Background: There are no evidence-based national guidelines for managing neonatal abstinence syndrome (NAS) and surveys from other countries have demonstrated considerable variations in practice. Objective: To describe NAS management practices in Canada. Method: The directors of all Level 2 and Level 3 neonatal intensive care units (NICUs) were contacted to request their participation in a structured telephone survey. Frequency distributions were generated and associations between practice variations and unit type (Level 2 or 3) and size were examined...
June 2017: Paediatrics & Child Health
Blanka Nechanská, Viktor Mravčík, Svetlana Skurtveit, Ingunn Olea Lund, Roman Gabrhelík, Anders Engeland, Marte Handal
BACKGROUND AND AIMS: Opioid maintenance treatment (OMT) is recommended to opioid dependent females during pregnancy. However, it is not clear which medication should be preferred. We aimed to compare neonatal outcomes after prenatal exposure to methadone (M) and buprenorphine (B) in two European countries. DESIGN: Nationwide register-based cohort study using personalized IDs assigned to all citizens for data linkage. SETTING: The Czech Republic (2000-2014) and Norway (2004-2013)...
February 14, 2018: Addiction
Denise J Maguire, Emily Shaffer-Hudkins, Kathleen Armstrong, Leah Clark
PURPOSE: The purpose of this study is to learn how caregivers who are expert in feeding infants with neonatal abstinence syndrome (NAS) successfully feed these infants during withdrawal. DESIGN/SAMPLE: Focus group methodology was used to gather information from self-identified experts from three large regional NICUs. Twelve NICU nurses and speech therapists participated in open-ended, recorded discussions. Detailed flip chart notes were taken, reviewed, and verified by the participants before the group ended...
January 1, 2018: Neonatal Network: NN
Anne Gadomski, Moira Riley, Katherine Ramiza, Lauren Onofrey, Ruth Zinkievich, Nicole Krupa, Melissa Scribani
OBJECTIVE: Our level I nursery and pediatric unit in a rural hospital adopted a family-centered, symptom-based oral morphine weaning protocol for Neonatal Abstinence Syndrome (NAS) in 2009. Length of stay (LOS), treatment duration (TD) and hospital charges for infants treated for NAS were then compared to published data in neonatal intensive care units (NICUs) nationwide. METHODS: The electronic medical records (EMRs) of infants born 1/1/11 to 4/1/17 whose discharge diagnosis included an ICD9 or ICD10 code for NAS or prenatal drug exposure were paired with maternal EMR and reviewed...
February 8, 2018: Academic Pediatrics
Karel Allegaert, Anne Smits, John van den Anker
Introduction Regulatory initiatives have stimulated drug research in infants, but the potential impact of drugs to improve health outcome in neonates remains underexplored. Areas covered In this review, we focus on current limitations in drug evaluation studies and how to overcome these. The low volume of studies has additional weaknesses such as single center studies, non-commercial sponsorship, overrepresentation of high postulated risk reductions, and underrepresentation of therapeutic exploratory studies...
February 8, 2018: Expert Review of Clinical Pharmacology
Laura J Faherty, Meredith Matone, Molly Passarella, Scott Lorch
BACKGROUND: The prevalence of opioid use during pregnancy is increasing. Two downstream effects are neonatal abstinence syndrome (NAS), a postnatal withdrawal syndrome, and long-term prenatal opioid exposure (LTPOE) without documented withdrawal symptoms in the infant. Mental health characteristics of mothers of infants with NAS and LTPOE have not been described. METHODS: Using linked maternal and infant Medicaid claims and birth certificate data, we analyzed 15,571 infants born to Medicaid-insured women 15-24 years old in a mid-Atlantic city from 2007 to 2010...
February 7, 2018: Maternal and Child Health Journal
Sonya MacVicar, Tracy Humphrey, Katrina E Forbes-McKay
BACKGROUND: Breastfeeding rates are typically low for women with a substance-use disorder. This is despite the specific benefits of breastfeeding to alleviate the severity of neonatal abstinence syndrome and the well-documented generic advantages. This study explored the feasibility of in-hospital, tailored breastfeeding support for the substance-exposed mother and baby. METHODS: This was a mixed-methods feasibility study undertaken in Scotland from April 2014 to May 2015...
February 7, 2018: Birth
Kathryn Dee L MacMillan, Cassandra P Rendon, Kanak Verma, Natalie Riblet, David B Washer, Alison Volpe Holmes
Importance: Rising incidence of neonatal abstinence syndrome (NAS) is straining perinatal care systems. Newborns with NAS traditionally receive care in neonatal intensive care units (NICUs), but rooming-in with mother and family has been proposed to reduce the use of pharmacotherapy, length of stay (LOS), and cost. Objective: To systematically review and meta-analyze if rooming-in is associated with improved outcomes for newborns with NAS. Data Sources: MEDLINE, CINAHL, The Cochrane Library, and clinicaltrials...
February 5, 2018: JAMA Pediatrics
Jennifer M McAllister, Eric S Hall, Gayle E R Hertenstein, Stephanie L Merhar, Patricia L Uebel, Scott L Wexelblatt
In this retrospective cohort study, we assessed the incidence of torticollis in infants with a history of neonatal abstinence syndrome. Understanding the elevated risk of torticollis in this population is important for early identification and treatment.
January 24, 2018: Journal of Pediatrics
(no author information available yet)
No abstract text is available yet for this article.
February 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Lara S Lemon, Ashley Naimi, Steve N Caritis, Robert W Platt, Raman Venkataramanan, Lisa M Bodnar
BACKGROUND: Pregnant women treated with methadone as opioid maintenance therapy are more likely than women treated with buprenorphine to deliver preterm. Preterm birth is associated with less risk of neonatal abstinence syndrome (NAS). We sought to assess the role of preterm birth as a mediator of the relationship between in utero exposure to methadone and NAS compared with buprenorphine. METHODS: We studied 716 women receiving methadone or buprenorphine and delivering liveborn infants at Magee-Womens Hospital, Pittsburgh, Pennsylvania (2013-15)...
January 26, 2018: Paediatric and Perinatal Epidemiology
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