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https://www.readbyqxmd.com/read/27926654/neonatal-abstinence-syndrome-and-ethical-approaches-to-the-identification-of-pregnant-women-who-use-drugs
#1
Mishka Terplan, Howard Minkoff
The United States is experiencing an epidemic of opioid use, addiction, and neonatal abstinence syndrome. Consequentially, a great deal of public, and public health, attention has turned toward the timely recognition of pregnant women who use drugs. We explore the clinical efficacy and ethical acceptability of different methods of identification-contrasting drug testing (using biologic samples such as urine) with screening (using an instrument or questionnaire) under both universal and selective approaches within the current legal and social landscape, which is fraught with potential adverse consequences for both the woman and her child...
December 2, 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27907936/early-treatment-for-neonatal-abstinence-syndrome-a-palliative-approach
#2
Jennifer Hudson, Rachel Mayo, Lori Dickes, Liwei Chen, Windsor Westbrook Sherrill, Julie Summey, Bradley Dalton, Kindal Dankovich
Objective To describe medical, safety, and health care utilization outcomes associated with an early treatment model for neonatal opioid withdrawal. Study Design This is a retrospective review of 117 opioid-exposed infants born in a large regional hospital and treated in the level I nursery with methadone initiated within 48 hours of birth. Results For this cohort, mean length of stay was 8.3 days. Hospital safety events were infrequent; there were no medication errors or deaths. Within 30 days of discharge, 14% of infants visited the emergency department; 7% were readmitted...
December 1, 2016: American Journal of Perinatology
https://www.readbyqxmd.com/read/27904516/serum-pregnancy-associated-plasma-protein-a-levels-in-the-first-second-and-third-trimester-of-pregnancy-relation-to-newborn-anthropometric-parameters-and-maternal-tobacco-smoking
#3
Magdalena Chełchowska, Joanna Gajewska, Joanna Mazur, Jadwiga Ambroszkiewicz, Tomasz M Maciejewski, Jerzy Leibschang
INTRODUCTION: The purpose of this study was to evaluate the associations of the first, second and third trimester serum pregnancy-associated plasma protein A (PAPP-A) concentrations with neonatal anthropometric parameters. The effect of tobacco smoking during pregnancy on PAPP-A level was also studied. MATERIAL AND METHODS: One hundred and fifty healthy pregnant women were divided into smoking and tobacco-abstinent groups. Serum PAPP-A level was measured with the KRYPTOR rapid random-access immunoassay analyzer...
December 1, 2016: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/27889436/wide-variation-found-in-care-of-opioid-exposed-newborns
#4
Debra L Bogen, Bonny L Whalen, Laura R Kair, Mark Vining, Beth A King
OBJECTIVE: Standardized practices for the management of neonatal abstinence syndrome (NAS) are associated with shorter lengths of stay, but optimal protocols are not established. We sought to identify practice variations for newborns with in utero chronic opioid exposure among hospitals in the Better Outcomes Through Research for Newborns (BORN) network. METHODS: Nursery site leaders completed a survey about hospitals' policies and practices regarding care for infants with chronic opioid exposure (≥3 weeks)...
November 23, 2016: Academic Pediatrics
https://www.readbyqxmd.com/read/27886650/the-relationship-between-gestational-age-and-the-severity-of-neonatal-abstinence-syndrome
#5
Kelly S Gibson, Ms Sydney Stark, Deepak Kumar, Jennifer L Bailit
BACKGROUND AND AIMS: The relationship between gestational age at delivery and the severity of neonatal abstinence syndrome (NAS) is poorly understood. Our objective was to compare the length of pharmacotherapy and hospital stay among opioid exposed infants born during the late preterm, early term, full term, and late term periods. DESIGN: Retrospective cohort study of infants affected by NAS SETTING: MetroHealth Medical Center in Cleveland, Ohio, USA: an urban tertiary care hospital serving as the referral center for opioid dependency in pregnancy with a level III neonatal intensive care unit PARTICIPANTS: All deliveries complicated by maternal opioid exposure from January 2000 to October 2014; 403 were eligible to be included (n = 102 Late Preterm, 34-36weeks (LP), n = 158 Early Term, 37-38weeks (ET), n = 122 Full Term, 39-40weeks (FT), n = 21 Late Term, ≥41 weeks (LT))...
November 25, 2016: Addiction
https://www.readbyqxmd.com/read/27881161/lower-hypoxic-ventilatory-response-in-smokers-compared-to-non-smokers-during-abstinence-from-cigarettes
#6
Wulf Hildebrandt, Roland Sauer, Ulrich Koehler, Peter Bärtsch, Ralf Kinscherf
BACKGROUND: Carotid body O2-chemosensitivity determines the hypoxic ventilatory response (HVR) as part of crucial regulatory reflex within oxygen homeostasis. Nicotine has been suggested to attenuate HVR in neonates of smoking mothers. However, whether smoking affects HVR in adulthood has remained unclear and probably blurred by acute ventilatory stimulation through cigarette smoke. We hypothesized that HVR is substantially reduced in smokers when studied after an overnight abstinence from cigarettes i...
November 24, 2016: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27876117/neonatal-abstinence-syndrome-and-the-gastrointestinal-tract
#7
Denise Maguire, Maureen Gröer
Development of a healthy gut microbiome is essential in newborns to establish immunity and protection from pathogens. Recent studies suggest that infants who develop dysbiosis may be at risk for lifelong adverse health consequences. Exposure to opioid drugs during pregnancy is a factor of potential importance for microbiome health that has not yet been investigated. Since these infants are born after an entire gestation exposed to mu opioid receptor agonists and have severe gastrointestinal and neurological symptoms, we hypothesize that these infants are at risk for dysbiosis...
December 2016: Medical Hypotheses
https://www.readbyqxmd.com/read/27859634/higher-alcohol-consumption-in-early-pregnancy-or-low-to-moderate-drinking-during-pregnancy-may-affect-children-s-behaviour-and-development-at-1-5-years
#8
Viveka Sundelin-Wahlsten, Gunilla Hallberg, Anders Helander
AIM: It is unclear if low-to-moderate alcohol consumption during pregnancy affects child development. This study examined the effects that a mother's self-reported alcohol consumption had on her pregnancy and her child's birth, behaviour and development. METHODS: We asked 291 Swedish women to report their alcohol consumption before and during pregnancy using the Alcohol Use Disorders Identification Test (AUDIT), provide data on their pregnancy, labour and neonatal period, and complete a child behaviour and development questionnaire when their child was 1...
November 15, 2016: Acta Paediatrica
https://www.readbyqxmd.com/read/27821184/a-core-outcome-set-for-neonatal-abstinence-syndrome-study-protocol-for-a-systematic-review-parent-interviews-and-a-delphi-survey
#9
Lauren E Kelly, Lauren M Jansson, Wendy Moulsdale, Jodi Pereira, Sarah Simpson, Astrid Guttman, Karel Allegaert, Lisa Askie, Henry Roukema, Thierry Lacaze, Jonathan M Davis, Loretta Finnegan, Paula Williamson, Martin Offringa
BACKGROUND: The prevalence of neonatal abstinence syndrome (NAS) is increasing globally resulting in an increased incidence of adverse neonatal outcomes and health system costs. Evidence regarding the effectiveness of NAS prevention and management strategies is very weak and further research initiatives are critically needed to support meta-analysis and clinical practice guidelines. In NAS research, the choice of outcomes and the use of valid, responsive and feasible measurement instruments are crucial...
November 8, 2016: Trials
https://www.readbyqxmd.com/read/27799240/observational-study-of-the-safety-of-buprenorphine-naloxone-in-pregnancy-in-a-rural-and-remote-population
#10
Naana Afua Jumah, Craig Edwards, Jazmyn Balfour-Boehm, Kassandra Loewen, Joseph Dooley, Lianne Gerber Finn, Len Kelly
OBJECTIVES: To describe the effect of in utero exposure to the buprenorphine+naloxone combination product in a rural and remote population. SETTING: A district hospital that services rural and remote, fly-in communities in Northwestern Ontario, Canada. PARTICIPANTS: A retrospective cohort study was conducted of 855 mother infant dyads between 1 July 2013 and 30 June 2015. Cases included all women who had exposure to buprenorphine+naloxone during pregnancy (n=62)...
October 31, 2016: BMJ Open
https://www.readbyqxmd.com/read/27729254/opioid-dependence-and-pregnancy-minimizing-stress-on-the-fetal-brain
#11
REVIEW
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 prompted a US Government Accountability Office report documenting deficits in research and provider knowledge about care of the maternal/fetal unit and the neonate. There are 3 general sources of dependence: untreated opioid use disorder, 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
https://www.readbyqxmd.com/read/27723910/neonatal-abstinence-syndrome-twelve-years-of-experience-at-a-regional-referral-center
#12
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
https://www.readbyqxmd.com/read/27695339/a-comparison-of-morphine-delivery-in-neonatal-opioid-withdrawal
#13
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
https://www.readbyqxmd.com/read/27679504/a-swedish-population-based-study-of-adverse-birth-outcomes-among-pregnant-women-treated-with-buprenorphine-or-methadone-preliminary-findings
#14
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
https://www.readbyqxmd.com/read/27669331/rates-of-neonatal-abstinence-syndrome-amid-efforts-to-combat-the-opioid-abuse-epidemic
#15
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
https://www.readbyqxmd.com/read/27647475/a-qualitative-study-of-family-experience-with-hospitalization-for-neonatal-abstinence-syndrome
#16
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
https://www.readbyqxmd.com/read/27636698/adding-to-our-practice-toolkit-using-the-acts-script-to-address-stigmatizing-peer-behaviors-in-the-context-of-maternal-substance-use
#17
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
https://www.readbyqxmd.com/read/27636696/pharmacotherapy-for-neonatal-abstinence-syndrome-choosing-the-right-opioid-or-no-opioid-at-all
#18
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
https://www.readbyqxmd.com/read/27636695/nonpharmacologic-management-of-neonatal-abstinence-syndrome-an-integrative-review
#19
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
https://www.readbyqxmd.com/read/27636694/characteristics-of-maternal-infant-interaction-during-treatment-for-opioid-withdrawal
#20
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
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