A survey of the management of neonatal opiate withdrawal in England and Wales

Morrison, Clive L.; Siney, Catherine

doi:10.1007/bf02002721

Cited by 19 publications

(8 citation statements)

References 6 publications

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“…Our audit highlights significant alterations in practice in the 14-year period since 1994 23. Approximately 94% of units now use an opioid (morphine or methadone) as recommended20 – 22 and this compares favourably with 83% of a recently published American cohort 24.…”

Section: Discussionmentioning

confidence: 94%

“…Three major reviews advocate an opiate as the drug of choice for neonatal opiate withdrawal 20 – 22. A survey of practice in the United Kingdom (UK) in 199423 highlighted that chlorpromazine was the agent most commonly utilised (70.8%), with opioids used in 10.8% of units. The purpose of our current manuscript is to present the results of the most comprehensive appraisal to date pertaining to management of NAS in the UK and Ireland.…”

mentioning

confidence: 99%

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Management of neonatal abstinence syndrome: a national survey and review of practice

O’Grady

Hopewell

White

2009

Archives of Disease in Childhood - Fetal and Neonatal Edition

100

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

Management of neonatal abstinence syndrome: a national survey and review of practice

O’Grady

Hopewell

White

2009

Archives of Disease in Childhood - Fetal and Neonatal Edition

100

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“…Chloral hydrate exerts an hypnotic effect through its active metabolite trichloroethanol. Although some neonatologists have used choral hydrate as a first line treatment for NAS infants, 21 there is no published evidence to support such a policy. Chlorpromazine is a neuroleptic which acts on the hypothalamus and brainstem.…”

Section: Pharmacological Actions Of Treatments Used For Nasmentioning

confidence: 99%

Treatment of neonatal abstinence syndrome

Johnson

Gerada²,

Greenough³

2003

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Neonatal abstinence syndrome (NAS) is suffered by infants withdrawing from substances on which they have become physically dependent after in utero exposure. They may require prolonged treatment and spend weeks or even months in hospital. A wide range of drugs have been used to treat NAS. The efficacy of few, however, have been adequately investigated. Evidence suggests that opioids are the most appropriate, at least in infants exposed to diamorphine or methadone. In all "head to head" trials, diazepam has been shown to be ineffective. Morphine and methadone are currently the most commonly prescribed opioids to treat NAS, but randomised trials have not been undertaken to determine which is the more beneficial. Many infants with NAS have been exposed to multiple substances in utero. Further research is required into whether a single opiate or a multiple drug regimen is the best option for such patients.

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“…3 In the United Kingdom, the incidence of drug exposed newborn infants varies between 14% and 90% of liveborn infants, depending on the urban area and social class of the population sampled. 4 More recently, anonymous screening of women attending antenatal clinics in London observed that 11-16% were using at least one illicit substance. 5 6 In the area served by Glasgow Royal Maternity Hospital, NAS has increased 10-fold over the last decade, paralleling the increased usage of methadone as opiate substitution for pregnant mothers with a history of drug use.…”

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confidence: 99%

A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome

Jackson

2004

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Background: The incidence of neonatal abstinence syndrome (NAS) has increased 10-fold over the last decade in Glasgow. In the Princess Royal Maternity Hospital, it now accounts for 17% of special care baby unit (SCBU) admissions. Objective: To compare opiate replacement therapy (morphine sulphate) with the present standard treatment (phenobarbitone) for management of NAS. The primary study end point was duration of pharmaceutical treatment. Secondary end points were the requirement for additional drugs and the requirement for SCBU admission. Design: Double blind, randomised controlled clinical trial. Methods: Differential diagnoses were excluded, and two consecutive Lipsitz scores . 4 defined NAS requiring treatment. Infants were randomised to receive morphine sulphate or phenobarbitone. Treatments were identical in appearance, odour, and volume. Increments, decrements, and discontinuation of treatments were protocol driven. Results: Seventy five infants participated. All mothers received opiate replacement therapy (methadone) during pregnancy and most used other drugs (n = 62, 83%). No significant difference in maternal drug use patterns was observed between treatment groups. Median treatment duration was four days shorter with opiate replacement (8 v 12 days, Mann-Whitney U test, p = 0.02). Phenobarbitone treated infants tended to require second line treatment (47% v 35%, x 2 test, p = 0.11) and SCBU admission (62% v 30%, x 2 test, p = 0.04) more often. Conclusions: Opiate replacement therapy appears to be superior for management of symptomatic NAS when maternal opiate use is prevalent. The shorter treatment duration and lower requirement for higher intensity nursing may have significant cost implications. Tailoring NAS treatment to local maternal drug use may result in similar benefits.

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A survey of the management of neonatal opiate withdrawal in England and Wales

Abstract: Drug misuse increasing in women of childbearing age and the management of the drug affected neonate varies widely, with inconsistent policies on determining the presence of NOW and how to treat it.

Cited by 19 publications

References 6 publications

Management of neonatal abstinence syndrome: a national survey and review of practice

Management of neonatal abstinence syndrome: a national survey and review of practice

Treatment of neonatal abstinence syndrome

A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome

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