Neonatal Abstinence Syndrome

Abstract: Methadone exposures in children have increased as the drug has gained more prevalence in the treatment of adult narcotic dependency. Previous literature concerning pediatric methadone ingestion has focused primarily on unintentional ingestions. We describe a 2-month-old male infant presenting with respiratory failure from suspected intentional methadone administration. Th

0. Archives of. Search. Letters| August 22/29, 2012. Neonatal Abstinence Syndrome Reply. ... Neonatal Abstinence Syndrome.

0. Archives of. Search. Letters| August 22/29, 2012. Neonatal Abstinence Syndrome. ... provides important data on US trends in maternal opioid use, neonatal abstinence syndrome ( NAS), and NAS-associated hospital costs.

NotesCite this as: BMJ 2012;344:e4200

The primary aim of this qualitative methods study was to describe the lived experiences of neonatal intensive care unit (NICU) nurses with ethical and morally challenging issues.|The target population for the study was registered nurses working in the NICU. Interviews were completed with 16 nurses from 1 hospital.|A phenomenological method design was used to describe NICU nurses' lived experiences with ethical and moral issues encountered in the NICU.|After obtaining signed consent, the principal investigator interviewed all participants, using a semistructured interview guide consisting of open-ended questions.|Ethical and moral distress related to neonatal abstinence syndrome was the predominant outcome.|Caring for infants, coping with families, and discharging infants home were the major concerns voiced by nurses in this study.|Nurses in this study struggled with issues of beneficence and nonmaleficence and were not aware of scientific evidence that guides methadone management of

Opioid use in pregnant women has increased over the last decade. Following birth, infants with in utero exposure demonstrate signs and symptoms of withdrawal known as the neonatal abstinence syndrome (NAS). Infants express a spectrum of disease, with most requiring the administration of pharmacologic therapy to ensure proper growth and development. Treatment often involves prolonged hospitalization. There is a general lack of high-quality clinical trial data to guide optimal therapy, and significant heterogeneity in treatment approaches. Emerging trends in the treatment of infants with NAS include the use of sublingual buprenorphine, transition to outpatient therapy, and pharmacogenetic risk stratification.

To assess the maternal and neonatal outcomes of pregnant women enrolled on a Methadone Substitution Programme (MSP).|Retrospective cohort study.|Maternity unit of a London teaching hospital and tertiary referral centre.|Pregnant women on a MSP whose antenatal care and delivery was at St Thomas' Hospital (STH) between January 2005 and March 2008. Controls were non-MSP mothers closely matched for age, parity and delivery date during the same period.|Maternal data was collected from the Liaison Antenatal Drugs and Alcohol Service clinic records and the STH Maternity Unit's computerised database. Neonatal data was extracted from the STH Neonatal database (part of the UK National Neonatal database).|Maternal profiles (age, gravidity, parity, ethnicity, BMI, smoking and alcohol history, relationship and employment history), pregnancy details and mode of delivery. Neonatal outcome measures to include gestation age at delivery, birth weight, head circumference, admission rates and length of

Methadone is often prescribed as a taper schedule to prevent/treat opioid abstinence syndrome (OAS) or neonatal abstinence syndrome (NAS).|The objective of this study was to determine the percentage of children discharged home on methadone tapers and to develop, assess, and implement an instrument for measuring the complexity of the methadone regimens.|This study used a descriptive retrospective design to examine patients younger than 18 years from January 1, 2008, to December 31, 2008, administered methadone for prevention/treatment of OAS/NAS and discharged home on a methadone taper. Data collection included demographics and characteristics of methadone regimen. The primary objective was to determine the percentage of children discharged on methadone. Secondary objectives included characterization (ie, number of dosage and interval changes), duration, and complexity of the methadone taper. Descriptive statistics were performed using Stata v10 (StataCorp LP, College Station, TX).

Methadone exposures in children have increased as the drug has gained more prevalence in the treatment of adult narcotic dependency. Previous literature concerning pediatric methadone ingestion has focused primarily on unintentional ingestions. We describe a 2-month-old male infant presenting with respiratory failure from suspected intentional methadone administration. The infant was born to a mother with narcotic dependency and at birth was treated for neonatal abstinence syndrome. After discharge for neonatal abstinence syndrome treatment, the infant continued to be fussy and persistently irritable. We believe the infant was intentionally given methadone at home by his mother for these symptoms. It is important for pediatric providers to be vigilant of households with methadone present. Family-centered education on prevention of methadone ingestion (eg, safe storage) and anticipatory guidance on the signs, symptoms, and treatment of toxicity are key.

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