Adverse neurodevelopmental outcome of infants exposed to opiate in-utero

Hunt, Rod W.; Tzioumi, Dimitra; Collins, Edith; Jeffery, Heather

doi:10.1016/j.earlhumdev.2007.01.013

Cited by 244 publications

(213 citation statements)

References 26 publications

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“…Indeed, these infants are more prone to both short-term and long-term problems. 173,174 Whether prenatal opioid exposure or postnatal opioid treatment has any long-term effects on the newborn brain is largely unknown. Indeed, no longitudinal follow-up studies have extended beyond the first few years of life.…”

Section: Discharge and Follow-upmentioning

confidence: 99%

“…No significant adverse long-term outcomes were reported among neonates who were exposed in utero to SSRIs, SNRIs, TCAs, benzodiazepines, or methamphetamines. [180][181][182] During follow-up, infants with NAS particularly require (1) neurodevelopmental assessments to identify motor deficits, cognitive delays, or relative microcephaly 174,183 ; (2) psycho-behavioral assessments to identify hyperactivity, impulsivity, and attention-deficit in preschool-aged children, as well as school absence, school failure, and other behavioral problems in schoolaged children 184 ; (3) ophthalmologic assessment to identify nystagmus, strabismus, refractive errors, and other visual defects [185][186][187] ; (4) growth and nutritional assessment to identify failure to thrive and short stature 174 ; and (5) family support assessments to exclude continuous maternal substance abuse and child abuse. Parents need to be educated about sudden infant deaths as well as complications due to perinatal infections.…”

Section: Discharge and Follow-upmentioning

confidence: 99%

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Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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Section: Discharge and Follow-upmentioning

confidence: 99%

Section: Discharge and Follow-upmentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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“…Une étude fait état d'un suivi d'une durée de six ans auprès de 15 enfants exposés à la méthadone ou la buprénorphine : comme groupe, leur poids à la naissance était inférieur à la moyenne nationale ; il y a eu deux morts subites du nouveau-né ; six enfants présentent un développement normal au suivi ; cinq présentent divers retards de développement et deux, un désordre hyperkinétique (Sandtory & al., 2009). Une autre étude portait sur 133 enfants avec une évaluation à 18 et 36 mois (Hunt, 2008). Des retards de croissance étaient observés ainsi que divers retards du développement mental, moteur et du langage.…”

Section: Drogues Santé Et Société Vol 10 N O 1 Juin 2011unclassified

Les effets indésirables des médicaments de substitution dans le traitement de la dépendance aux opioïdes

Lauzon

2012

dss

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Le traitement de substitution, principalement avec la méthadone ou la buprénorphine, représente le traitement le plus efficace de la dépendance des opioïdes. Ces médicaments doivent, la plupart du temps, être pris pendant des périodes prolongées, soit plusieurs années ou toute la vie pour certains. Ces médicaments peuvent avoir des effets indésirables, ayant un impact sur la qualité de vie des patients, et nécessitent une attention de la part des professionnels de la santé impliqués dans le traitement. Seront révisés les effets indésirables suivants : hypogonadisme masculin, allongement du QT, sevrage néonatal, anomalies des fonctions respiratoires, hyperalgésie, risque d’intoxication, abus de la médication, interactions médicamenteuses. À ces effets pharmacologiques viennent s’ajouter des contraintes réglementaires, qui, si elles peuvent être pertinentes en début de traitement, s’avèrent lourdes et inadaptées pour les patients stables depuis plusieurs années. De l’écoute et une bonne gestion de ces effets indésirables sont indispensables pour améliorer l’acceptabilité du traitement et son attrait pour les usagers.

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“…Methadone substantially minimizes the peak and trough in maternal serum opioid levels that typically occur with repeat use of short-acting opioids such as heroin, thereby reducing the harm that the fetus encounters as a result of repeated intoxication and withdrawal [13]. Methadone use during pregnancy has been associated with improved prenatal care, [14] longer gestation, [15] higher birthweight, [16] and increased rates of infants discharged home in the care of their mothers [17]. In hospital, the dosage of methadone is tailored to the mother's tolerance of symptoms and is titrated over a 24-hour period to avoid fluctuations in levels of methadone in the fetal circulation.…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, if symptoms are not well controlled with methadone use, or perhaps even if they are, women frequently continue to use other drugs [18]. Methadone itself is highly addictive and is implicated as a cause of adverse fetal/neonatal sequelae [19,20]. Methadone-exposed babies have demonstrated reduced birth weight and head circumference, prematurity, [21] and rates of neonatal withdrawal syndrome ranging from 46% [22] to 97% [12,23].…”

Section: Introductionmentioning

confidence: 99%

Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol

Janssen¹,

Kelly²,

Thiessen³

et al. 2013

Deutsche Zeitschrift für Akupunktur

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Background: The prevalence of maternal drug use during pregnancy in North America has been estimated to be as high as 6-10%. The consequences for the newborn include increased risk for perinatal mortality and ongoing physical, neurobehavioral, and psychosocial problems. Methadone is frequently used to wean women off street drugs but is implicated as a cause of adverse fetal/neonatal outcomes itself. The purpose of our study was to test the ability of maternal acupuncture treatment among mothers who use illicit drugs to reduce the frequency and severity of withdrawal symptoms among their newborns. Methods: We randomly assigned chemically dependent pregnant women at BC Women's Hospital in Vancouver, British Columbia to daily acupuncture treatments versus usual care. By necessity, neither our participants nor acupuncturists were blinded as to treatment allocation. Our primary outcome was days of neonatal morphine treatment for symptoms of neonatal withdrawal. Secondary neonatal outcomes included admission to a neonatal ICU and transfer to foster care. Results: We randomized 50 women to acupuncture and 39 to standard care. When analyzed by randomized groups, we did not find benefit of acupuncture; the average length of treatment with morphine for newborns in the acupuncture group was 2.7 (6.3) compared to 2.8 (7.0) in the control group. Among newborns of women who were compliant with the acupuncture regime, we observed a reduction of 2.1 and 1.5 days in length of treatment for neonatal abstinence syndrome compared to the non-compliant and control groups, respectively. These differences were not statistically significant. Conclusions: Acupuncture may be a safe and feasible treatment to assist mothers to reduce their dosage of methadone. Our results should encourage ongoing studies to test the ability of acupuncture to mitigate the severity of neonatal abstinence syndrome among their newborns. Clinical Trial Registration: http://www.clinicaltrials.gov registry: W05-0041

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Adverse neurodevelopmental outcome of infants exposed to opiate in-utero

Cited by 244 publications

References 26 publications

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome

Les effets indésirables des médicaments de substitution dans le traitement de la dépendance aux opioïdes

Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol

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