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neonatal abstinence

John J Mccarthy, Martin H Leamon, Loretta P Finnegan, Catherine Fassbender
Increase in the number of opioid dependent pregnant women delivering babies at risk for neonatal abstinence syndrome (NAS) prompted a General Accountability Office (GAO) report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are three general sources of dependence: untreated opioid use disorder (OUD), pain management, and medication assisted treatment with methadone or buprenorphine. A survey of methadone patients' experiences when telling a physician of their pregnancy and opioid dependence demonstrated physician confusion about proper care, frequent negative interactions with the mother, and failures to provide appropriate referral...
October 8, 2016: American Journal of Obstetrics and Gynecology
S Mücke, M Nagel, J P Siedentopf, C Bührer, D Hüseman
Background: Infants exposed to opiates antenatally display withdrawal symptoms after birth referred to as neonatal abstinence syndrome (NAS). Patients: A total of 366 newborns (166 females, 10 twins) from 361 mothers were diagnosed with NAS from 2000 to 2011 at a single large metropolitan referral center. Methods: Retrospective chart review of all newborn infants exposed to opiates in utero. Results: 20% were premature (gestational age<37 weeks), 32% were small-for-gestational-age (<10(th) percentile)...
October 10, 2016: Klinische Pädiatrie
Brian Chisamore, Safaa Labana, Sandra Blitz, Alice Ordean
Current estimates of the prevalence of opioid withdrawal in newborns from the 2012 Better Outcomes Registry and Network Ontario reveal that more than 4 births per 1000 display recognizable symptoms of neonatal abstinence syndrome (NAS). With a growing consensus surrounding aspects of newborn opioid withdrawal care, clinicians might agree that all infants exposed to maternal opioids require supportive observation and care to ensure appropriate adaptation and growth in the newborn period and, likewise, that there exists a smaller percentage of newborns who require additional pharmacotherapy...
2016: Substance Abuse: Research and Treatment
Keele E Wurst, Barbara K Zedler, Andrew R Joyce, Maciek Sasinowski, E Lenn Murrelle
BACKGROUND: Untreated opioid dependence in pregnant women is associated with adverse birth outcomes. Buprenorphine and methadone are options for opioid agonist medication-assisted treatment during pregnancy. OBJECTIVE: The aim of this study was to describe adverse birth outcomes observed with buprenorphine or methadone treatment compared to the general population in Sweden. METHODS: Pregnant women and their corresponding births during 2005-2011 were identified in the Swedish Medical Birth Register...
2016: Substance Abuse: Research and Treatment
Joshua D Brown, Pratik A Doshi, Nathan J Pauly, Jeffery C Talbert
No abstract text is available yet for this article.
September 26, 2016: JAMA Pediatrics
Emily C Atwood, Grace Sollender, Erica Hsu, Christine Arsnow, Victoria Flanagan, Joanna Celenza, Bonny Whalen, Alison V Holmes
BACKGROUND AND OBJECTIVES: Although the incidence of neonatal abstinence syndrome (NAS) in the United States quintupled between 2000 and 2012, little is known about the family perspective of the hospital stay. We interviewed families to understand their experiences during the newborn hospitalization for NAS and to improve family-centered care. METHODS: A multidisciplinary team from 3 hospital units composed open-ended interview questions based on a literature review, clinical experience, and an internal iterative process...
October 2016: Hospital Pediatrics
Lenora Marcellus, Elizabeth Poag
Infants with neonatal abstinence syndrome (NAS) are a growing population in the NICU setting, and nurses report that caring for families can be challenging. Women who are pregnant and newly parenting who use drugs and alcohol typically face significant negative attitudes, judgment, and stigma within their communities and from providers when they access health care. When nurses witness biased behavior or communication from their peers, they may feel distressed and unprepared to address the situation. Using script guides or structured communication frameworks (e...
2016: Neonatal Network: NN
Christopher McPherson
Neonatal abstinence syndrome (NAS) from in utero opioid exposure has reached epidemic levels in the United States. Although nonpharmacologic therapies form the foundation of care, many neonates require pharmacotherapy. Morphine represents the most widely used first-line agent and effectively treats the symptoms of withdrawal. However, methadone or buprenorphine may facilitate earlier discharge. Although phenobarbital is traditionally used when opioids fail, clonidine may be a more appropriate adjunctive agent to minimize negative neurodevelopmental impact...
2016: Neonatal Network: NN
Lindy Edwards, Lisa F Brown
Neonatal abstinence syndrome (NAS) affects 3.39 in every 1,000 live births. A literature review was conducted to determine the varying types of nonpharmacologic management being used currently and its effect on the treatment of NAS symptoms. Fourteen articles were found that used nonpharmacologic management in the treatment of NAS. Therapies included breastfeeding, positioning, rooming-in, acupuncture/acupressure, and beds. Each of the nonpharmacologic therapies in these articles, with the exception of rocking beds, was shown to have a positive effect on the newborn with NAS...
2016: Neonatal Network: NN
Denise J Maguire, Susan Taylor, Kathleen Armstrong, Emily Shaffer-Hudkins, Rita DeBate, Aaron M Germain, Sandra S Brooks
PURPOSE: The purpose of this study was to describe the interactions between mothers in a methadone treatment program and their infants during a bottle feeding and compare the findings with normed data. DESIGN: A comparative-descriptive design was used. SAMPLE: Data from 12 opiate-exposed mother-infant dyads were compared with normed data. MAIN OUTCOME VARIABLE: Nursing Child Assessment Satellite-Training Scale scores...
2016: Neonatal Network: NN
Monica Marie Nelson
PURPOSE: The purpose of this focused ethnography was to describe the culture of care and nonpharmacologic nursing interventions performed by NICU nurses for infants with neonatal abstinence syndrome (NAS). METHOD: Roper and Shapira's framework for the analysis included participant observation, individual interviews, and examination of existing documents. SAMPLE: Twelve full-time nurses were observed and interviewed. RESULTS: Results described the culture of care provided to infants with NAS by NICU nurses as evidenced by six themes: learn the baby (routine care, comfort care, environment, adequate rest and sleep, feeding), core team relationships (support, interpersonal relationships), role satisfaction (nurturer/comforter, becoming an expert), grief, making a difference (wonderful insanity, critical to them), and education and care of the mother...
2016: Neonatal Network: NN
Denise J Maguire, Susan Taylor, Kathleen Armstrong, Emily Shaffer-Hudkins, Aaron M Germain, Sandra S Brooks, Genieveve J Cline, Leah Clark
Parents of infants with neonatal abstinence syndrome (NAS) in the NICU may have questions about the long-term consequences of prenatal exposure to methadone, both asked and unasked. Although the signs of withdrawal will abate relatively quickly, parents should be aware of potential vision, motor, and behavioral/cognitive problems, as well as sleeping disturbances and ear infections so their infants can be followed closely and monitored by their pediatrician with appropriate referrals made. Furthermore, this knowledge may inspire parents to enroll their infants in an early intervention program to help optimize their outcomes...
2016: Neonatal Network: NN
Lenora Marcellus
No abstract text is available yet for this article.
2016: Neonatal Network: NN
Karen D'Apolito
No abstract text is available yet for this article.
2016: Neonatal Network: NN
Elizabeth Allocco, Marjorie Melker, Florencia Rojas-Miguez, Caitlin Bradley, Kristen A Hahn, Elisha M Wachman
BACKGROUND: Twenty percent to 40% of infants exposed to in utero opioid were delivered preterm. There is currently no neonatal abstinence syndrome (NAS) scoring tool known to accurately evaluate preterm opioid-exposed infants. This can lead to difficulties in titrating pharmacotherapy in this population. PURPOSE: To describe NAS symptoms in preterm opioid-exposed infants in comparison with matched full-term controls. METHODS: This was a retrospective cohort study from a single tertiary care center of methadone-exposed infants born between 2006 and 2010...
October 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Cheryl Cirillo, Kim Francis
BACKGROUND: The United States is in an opioid crisis with abuse among women on the rise over the past 10 years. Infants of opioid-dependent mothers are at risk for neonatal abstinence syndrome (NAS). Neonatal abstinence syndrome can affect multiple systems and disrupt normal growth and development. It is for this reason that strategies to promote health such as breastfeeding need to be explored. This brief evaluates current evidence regarding breast milk and the impact it has on NAS. PURPOSE: The question guiding this brief is: "Does provision of breast milk reduce NAS withdrawal symptoms, decrease length of stay, and decrease the need for pharmacologic therapy for infants whose mothers are maintained on methadone or buprenorphine?" SEARCH STRATEGY: CINHAL/MEDLINE Complete and PubMed databases were searched using key words-NAS and breastfeeding-and the search was limited to 10 years for English studies evaluating the effects of breast milk on severity of NAS, pharmacologic therapy, and length of stay whose mothers received methadone or buprenorphine during pregnancy...
August 25, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Lauren M Jansson, Nancy Spencer, Krystle McConnell, Martha Velez, Michelle Tuten, Cheryl A Harrow, Hendrée E Jones, Madeleine J Swortwood, Allan J Barnes, Karl B Scheidweiler, Marilyn A Huestis
BACKGROUND: In addition to the well-known benefits of human milk and breastfeeding for the mother and infant, breastfeeding may mitigate neonatal abstinence syndrome severity in prenatally opioid-exposed infants. However, lack of conclusive data regarding the extent of the presence of buprenorphine and active metabolites in human milk makes the recommendation of breastfeeding for buprenorphine-maintained women difficult for many providers. OBJECTIVE: This study seeks to determine the concentrations of buprenorphine and its active metabolites (norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide) in human milk, maternal plasma, and infant plasma of buprenorphine-maintained women and their infants...
August 25, 2016: Journal of Human Lactation: Official Journal of International Lactation Consultant Association
Susan B Brogly, Kristen A Hahn, Sonia Hernandez Diaz, Martha Werler
Prenatal opioid agonist therapy with methadone or buprenorphine prevents maternal illicit opioid use and withdrawal and improves pregnancy outcomes compared to heroin use alone. Historically, methadone has been the first-line opioid agonist therapy for pregnant opioid dependent women; in recent years buprenorphine has become first-line treatment for some opioid dependent pregnant women. While there is some evidence of better outcomes in neonates exposed to buprenorphine vs. methadone, the effect of confounding from differences in women who use buprenorphine and methadone has not been carefully examined in most studies...
December 2015: Journal of Addiction Research & Therapy
Vanessa L Short, Meghan Gannon, Diane J Abatemarco
OBJECTIVE: The incidence of neonatal abstinence syndrome (NAS), a drug withdraw syndrome mainly associated with intrauterine opioid exposure, has increased considerably in the United States since 2000. Nonpharmacological options, including breastfeeding, may be effective at improving outcomes in this population. The objective of this population-based study was to examine the association between breastfeeding and length of hospital stay among infants diagnosed with NAS. METHODS: This was a retrospective cohort study of singleton in-hospital births to resident mothers in Pennsylvania...
September 2016: Breastfeeding Medicine: the Official Journal of the Academy of Breastfeeding Medicine
Michael McCarthy
No abstract text is available yet for this article.
2016: BMJ: British Medical Journal
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