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https://www.readbyqxmd.com/read/29763579/social-ecological-examination-of-factors-that-influence-the-treatment-of-newborns-with-neonatal-abstinence-syndrome
#1
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...
May 12, 2018: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/29757685/the-effect-of-standardizing-treatment-when-managing-neonatal-abstinence-syndrome
#2
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
https://www.readbyqxmd.com/read/29754866/outpatient-pharmacotherapy-for-neonatal-abstinence-syndrome
#3
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...
May 7, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29747726/opioid-use-disorders-and-pregnancy
#4
REVIEW
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
https://www.readbyqxmd.com/read/29746453/access-to-syringe-services-programs-kentucky-north-carolina-and-west-virginia-2013-2017
#5
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
https://www.readbyqxmd.com/read/29740196/quality-improvement-initiative-to-improve-inpatient-outcomes-for-neonatal-abstinence-syndrome
#6
Elisha M Wachman, Matthew Grossman, Davida M Schiff, Barbara L Philipp, Susan Minear, Elizabeth Hutton, Kelley Saia, Fnu Nikita, Ahmad Khattab, Angela Nolin, Crystal Alvarez, Karan Barry, Ginny Combs, Donna Stickney, Jennifer Driscoll, Robin Humphreys, Judith Burke, Camilla Farrell, Hira Shrestha, Bonny L Whalen
OBJECTIVES: To improve Neonatal Abstinence Syndrome (NAS) inpatient outcomes through a comprehensive quality improvement (QI) program. DESIGN: Inclusion criteria were opioid-exposed infants ≥36 weeks. QI methodology including stakeholder interviews and plan-do-study-act (PDSA) cycles were utilized. We compared pre- and post-intervention NAS outcomes after a QI initiative that included: A non-pharmacologic care bundle, function-based assessments consisting of symptom prioritization and then the "Eat, Sleep, Console" (ESC) Tool; and a switch to methadone for pharmacologic treatment...
May 8, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29739484/outpatient-pharmacologic-weaning-for-neonatal-abstinence-syndrome-a-systematic-review
#7
Jodie Murphy-Oikonen, Karen McQueen
AimThe purpose of this systematic review was to assess the literature regarding the effectiveness and safety of outpatient pharmacologic weaning for infants with neonatal abstinence syndrome (NAS). BACKGROUND: NAS is a multi-system disorder observed in infants experiencing withdrawal from opioid exposure in utero. Infants requiring pharmacologic treatment to manage withdrawal, traditionally receive treatment as a hospital inpatient resulting in lengthy hospitalization periods. However, there is evidence to suggest that some healthcare institutions are continuing outpatient pharmacologic weaning for select infants in a home environment...
May 9, 2018: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/29618930/symptoms-associated-with-attention-deficit-hyperactivity-disorder-and-autism-spectrum-disorders-in-school-aged-children-prenatally-exposed-to-substances
#8
Lisbeth Beate Sandtorv, Silje Katrine Elgen Fevang, Sondre Aasen Nilsen, Tormod Bøe, Rolf Gjestad, Siren Haugland, Irene Bircow Elgen
Prenatal exposure to substances may influence a child's neurodevelopment and impact on subsequent mental health. In a hospital-based population of school-aged children prenatally exposed to opiates and a number of illicit substances (n = 57), we evaluated mental health symptoms associated with attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) using the Swanson, Nolan, and Pelham Questionnaire, revision IV (SNAP-IV) and the Autism Spectrum Screening Questionnaire (ASSQ) and compared the scores to a reference group which comprised children from the population-based Bergen Child Study (n = 171)...
2018: Substance Abuse: Research and Treatment
https://www.readbyqxmd.com/read/29616150/methadone-treatment-of-opiate-addiction-a-systematic-review-of-comparative-studies
#9
REVIEW
Shahid Ali, Barira Tahir, Shagufta Jabeen, Madeeha Malik
Opiate misuse is a chronic relapsing disease that has become an epidemic in the United States. Methadone is the mainstay of treatment for opiate addiction and has been researched widely. Recently, new avenues of treatment have been researched and developed. The objective of this review is to study methadone in comparison to other pharmacological options available or being considered for opiate addiction treatment through a methodical search and review of evidence provided by recent clinical trials conducted in this regard...
July 2017: Innovations in Clinical Neuroscience
https://www.readbyqxmd.com/read/29614184/neonatal-abstinence-syndrome-advances-in-diagnosis-and-treatment
#10
REVIEW
Elisha M Wachman, Davida M Schiff, Michael Silverstein
Importance: Neonatal abstinence syndrome, which occurs as a result of in utero opioid exposure, affects between 6.0 and 20 newborns per 1000 live US births. There is substantial variability in how neonatal abstinence syndrome is diagnosed and managed. Objective: To summarize key studies examining the diagnosis and management (both pharmacologic and nonpharmacologic) of neonatal abstinence syndrome published during the past 10 years. Evidence Review: PubMed, Web of Science, and CINAHL were searched for articles published between July 1, 2007, and December 31, 2017...
April 3, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29595550/changing-neonatal-nurses-perceptions-of-caring-for-infants-experiencing-neonatal-abstinence-syndrome-and-their-mothers-an-evidenced-based-practice-opportunity
#11
Kobi Brooke Tobin
BACKGROUND: Neonatal intensive care units (NICUs) are caring for an increasing number of infants born with neonatal abstinence syndrome (NAS). The literature identifies the need for education for NICU nurses on NAS including skills for interacting with the mother with substance use disorder. PURPOSE: An evidence-based practice project was developed to offer an educational presentation targeting these topics to 206 NICU participants (93% registered nurses, 1% licensed vocational nurses, and 6% nursing assistants) at a level IV NICU...
April 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29580450/opioid-utilization-by-pregnant-women-with-sickle-cell-disease-and-the-risk-of-neonatal-abstinence-syndrome
#12
Aisha Nnoli, Neil S Seligman, Kevin Dysart, Jason K Baxter, Samir K Ballas
BACKGROUND: Pregnant women with sickle cell disease (SCD) are at increased risk of maternal and fetal complications. There are limited data on the outcome of the treatment of VOCs with opioids in relation to neonatal complications during pregnancy. METHODS: This is a retrospective cohort study of women with SCD from January 1999 to December 2008. Women with SCD were identified by ICD-9 codes and matched 2:1 to a control group of women on methadone for opioid dependence...
April 2018: Journal of the National Medical Association
https://www.readbyqxmd.com/read/29575474/epigenetic-variation-in-oprm1-gene-in-opioid-exposed-mother-infant-dyads
#13
Elisha M Wachman, Marie J Hayes, Hira Shrestha, Fnu Nikita, Angela Nolin, Leonie Hoyo, Katrina Daigle, Hendrée E Jones, David A Nielsen
Neonatal abstinence syndrome (NAS) due to in-utero opioid exposure has significant variability of severity. Preliminary studies have suggested that epigenetic variation within the μ-opioid receptor (OPRM1) gene impacts NAS. We aimed to determine if DNA methylation in OPRM1 within opioid-exposed mother-infant dyads is associated with differences in NAS severity in an independent cohort. Full-term opioid-exposed newborns and their mothers (N=68 pairs) were studied. A DNA sample was obtained and then assessed for level of DNA methylation at 20 CpG sites within the OPRM1 promoter region by next-generation sequencing...
March 25, 2018: Genes, Brain, and Behavior
https://www.readbyqxmd.com/read/29572587/neonatal-abstinence-syndrome-nas-in-southwestern-border-states-examining-trends-population-correlates-and-implications-for-policy
#14
Khaleel S Hussaini, Luigi F Garcia Saavedra
Introduction Neonatal abstinence syndrome (NAS) is withdrawal syndrome in newborns following birth and is primarily caused by maternal drug use during pregnancy. This study examines trends, population correlates, and policy implications of NAS in two Southwest border states. Materials and Methods A cross-sectional analysis of Hospital Inpatient Discharge Data (HIDD) was utilized to examine the incidence of NAS in the Southwest border states of Arizona (AZ) and New Mexico (NM). All inpatient hospital births in AZ and NM from January 1, 2008 through December 31, 2013 with ICD9-CM codes for NAS (779...
March 23, 2018: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/29572288/incidence-and-costs-of-neonatal-abstinence-syndrome-among-infants-with-medicaid-2004-2014
#15
Tyler N A Winkelman, Nicole Villapiano, Katy B Kozhimannil, Matthew M Davis, Stephen W Patrick
OBJECTIVES: To describe incidence, health care use, and cost trends for infants with neonatal abstinence syndrome (NAS) who are covered by Medicaid compared with other infants. METHODS: We used 2004-2014 hospital birth data from the National Inpatient Sample, a nationally representative sample of hospital discharges in the United States ( N = 13 102 793). Characteristics and trends among births impacted by NAS were examined by using univariate statistics and logistic regression...
April 2018: Pediatrics
https://www.readbyqxmd.com/read/29547380/maternal-opioid-use-disorder-and-neonatal-abstinence-syndrome-in-northwest-ontario-a-7-year-retrospective-analysis
#16
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
https://www.readbyqxmd.com/read/29520355/the-epidemic-of-neonatal-abstinence-syndrome-historical-references-of-its-origins-assessment-and-management
#17
REVIEW
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
https://www.readbyqxmd.com/read/29516490/the-pharmacokinetics-and-pharmacodynamics-of-buprenorphine-in-neonatal-abstinence-syndrome
#18
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
https://www.readbyqxmd.com/read/29515226/finding-the-right-treatment-for-neonatal-abstinence-syndrome-is-this-the-right-time
#19
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
https://www.readbyqxmd.com/read/29515225/retrospective-review-of-neurodevelopmental-outcomes-in-infants-treated-for-neonatal-abstinence-syndrome
#20
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
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