Comparison of Neonatal Abstinence Syndrome Manifestations in Preterm Versus Term Opioid-Exposed Infants

Allocco, Elizabeth; Melker, Marjorie; Rojas-Miguez, Florencia; Bradley, Caitlin; Hahn, Kristen A.; Wachman, Elisha M.

doi:10.1097/anc.0000000000000320

Cited by 44 publications

(36 citation statements)

References 33 publications

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“…NAS infants were also more often premature, despite that we excluded early preterm infants (<32 weeks) to reduce confounding. While this prematurity data is consistent with several Australian and Swedish studies 24 , 26 , 27 , there is also existing data to suggest that NAS may be less symptomatic in preterm infants 28 or that preterm infants may be less likely to develop NAS 29 . Infants with NAS in our study also had longer lengths of stay at birth hospitalization than unexposed infants and greater likelihood of neonatal ICU admission, which may relate to their need supportive care, potentially including pharmacologic (primarily morphine during the timeframe of this study 30 , 31 ), or non-pharmacologic interventions 32 .…”

Section: Discussionsupporting

confidence: 88%

Neonatal abstinence syndrome and early childhood morbidity and mortality in Washington state: a retrospective cohort study

et al. 2017

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ObjectiveTo evaluate the association between neonatal abstinence syndrome (NAS) and long-term childhood morbidity and infant mortality.Study designWe conducted a cohort study of infants born in Washington State during 1990–2008 who were diagnosed with NAS (n=1,900) or were unexposed (n=12,283, frequency matched by birth year). Five-year hospital readmissions and infant mortality were ascertained.ResultChildren with history of NAS had increased risk of readmission during the first five years of life relative to unexposed children; this remained statistically significant after adjustment for maternal age, maternal education, gestational age, and intrapartum smoking status (readmission rates: NAS=21.3%, unexposed=12.7%, aRR 1.54, 95% CI 1.37–1.73). NAS was associated with increased unadjusted infant mortality risk, but this did not persist after adjustment (aRR 1.94, 95% CI 0.99–3.80).ConclusionThe observed increased risk for childhood hospital readmission following NAS diagnosis argues for development of early childhood interventions to prevent morbidity.

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Section: Discussionsupporting

confidence: 88%

Neonatal abstinence syndrome and early childhood morbidity and mortality in Washington state: a retrospective cohort study

et al. 2017

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“…Although not initially designed for nonopioids, they have commonly been applied in the setting of exposure to these drugs. Their use in preterm infants may be limited due to the potentially different clinical expressions of withdrawal related to their developmental immaturity of the CNS . Moreover, concomitant need for specific therapies (e.g., sedatives in intubated patients) may further complicate withdrawal sign evaluation in preterm babies .…”

Section: Diagnosismentioning

confidence: 99%

“…Moreover, concomitant need for specific therapies (e.g., sedatives in intubated patients) may further complicate withdrawal sign evaluation in preterm babies . All in all, these tools may not be accurate for NAS evaluation in infants with lower gestational ages . The use of questionnaires to investigate maternal drug consumption may help to identify the mothers and infants at risk, although maternal self‐reporting on drug abuse is generally inaccurate and unreliable .…”

Section: Diagnosismentioning

confidence: 99%

Neonatal Abstinence Syndrome: Update on Diagnostic and Therapeutic Strategies

et al. 2017

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Substance use among pregnant women is a major public health issue. Both prescription opioid use and illicit opioid abuse have increased dramatically in recent years. Prolonged in utero drug exposure may result in neonatal abstinence syndrome (NAS), an acute multisystemic clinical entity that occurs in the first days of life. This syndrome is caused by abrupt discontinuation of fetal exposure to licit or illicit drugs chronically consumed by the mother during pregnancy and transmitted to the fetus through the placenta. It usually requires prolonged hospitalization and may have long-term effects. The interplay of many factors contributes to its clinical heterogeneity, and its pathophysiology has not been fully unveiled. The first step in NAS management consists of nonpharmacologic interventions and includes promoting breastfeeding when not contraindicated. If withdrawal signs become severe, pharmacotherapy is needed. The Finnegan scoring system supports care providers across the pharmacotherapy process from initiation through the monitoring phase, until weaning and discontinuation. However, a standardized approach to pharmacotherapy is still lacking. Morphine is usually the first-line agent to treat NAS. Methadone is a valid option, but its safety profile is not completely known. Phenobarbital, despite its lack of effect on gastrointestinal symptoms and unfavorable pharmacologic features, has been identified as a second-line agent to be used in infants unresponsive to opiates. Although buprenorphine and clonidine seem promising, their use requires further validation. Long-term developmental effects of NAS therapy call for more-comprehensive, longitudinal assessments. In this article, key points for use of recommended therapies are outlined, and directions for future research are suggested.

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“…In LDS patients, pulmonary valve stenosis could also develop over time (21). Similar to MFS, MVP and mitral valve insufficiency are more frequently observed than in the general population (27,35), but appear to be somewhat less common in LDS compared to MFS (36).…”

Section: Cardiovascular Featuresmentioning

confidence: 99%

Differences in manifestations of Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome

Meester

Verstraeten

Schepers

et al. 2017

Ann. Cardiothorac. Surg.

220

184

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Many different heritable connective tissue disorders (HCTD) have been described over the past decades.These syndromes often affect the connective tissue of various organ systems, including heart, blood vessels, skin, joints, bone, eyes, and lungs. The discovery of these HCTD was followed by the identification of mutations in a wide range of genes encoding structural proteins, modifying enzymes, or components of the In contrast, no association is reported between LDS and the presence of ectopia lentis, a key distinguishing feature of MFS. Overlapping features between MFS and LDS include scoliosis, pes planus, anterior chest deformity, spontaneous pneumothorax, and dural ectasia. EDS refers to a group of clinically and genetically heterogeneous connective tissue disorders and all subtypes are characterized by variable abnormalities of skin, ligaments and joints, blood vessels, and internal organs. Typical presenting features include joint hypermobility, skin hyperextensibility, and tissue fragility. Up to one quarter of the EDS patients show aortic aneurysmal disease. The latest EDS nosology distinguishes 13 subtypes. Many phenotypic features show overlap between the different subtypes, which makes the clinical diagnosis rather difficult and highlights the importance of molecular diagnostic confirmation.

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Comparison of Neonatal Abstinence Syndrome Manifestations in Preterm Versus Term Opioid-Exposed Infants

Cited by 44 publications

References 33 publications

Neonatal abstinence syndrome and early childhood morbidity and mortality in Washington state: a retrospective cohort study

Neonatal abstinence syndrome and early childhood morbidity and mortality in Washington state: a retrospective cohort study

Neonatal Abstinence Syndrome: Update on Diagnostic and Therapeutic Strategies

Differences in manifestations of Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome

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