Neonatal Abstinence Syndrome and Associated Neonatal and Maternal Mortality and Morbidity

Lisonkova, Sarka; Richter, Lindsay L; Ting, Joseph; Muraca, Giulia M.; Mehrabadi, Azar; Mitchell-Foster, Sheona; Oviedo‐Joekes, Eugenia; Lyons, Janet

doi:10.1542/peds.2018-3664

Cited by 23 publications

(13 citation statements)

References 25 publications

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“…Previous research has shown that compared with unexposed infants, infants with POE and NAS have an increased risk of low birth weight (Lisonkova et al 2019;Nørgaard et al 2015), preterm birth (birth before 37 weeks) (Alemu et al 2020;Brogly et al 2021;Corsi et al 2020;Maeda et al 2014) and stillbirth (Alemu et al 2020;Maeda et al 2014); and have poor fetal growth (Alemu et al 2020;Maeda et al 2014). The teratogenic effects of POE are still not well understood.…”

Section: Perinatal and Infant Health Outcomesmentioning

confidence: 99%

Reviewing the Evidence on Prenatal Opioid Exposure to Inform Child Development Policy and Practice

Camden¹,

Harris²,

Otter-Moore³

et al. 2021

hcq

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Prenatal opioid use is increasingly common and can have adverse impacts on maternal and child health. In Ontario, there are no clear guidelines or universal programs to support the healthy development of children with prenatal opioid exposure. We present the epidemiology of prenatal opioid exposure in Ontario, summarize research examining child health outcomes with a focus on child development, review emerging guidelines for child health and developmental surveillance and highlight promising programs. We emphasize the need to strengthen current Canadian recommendations for routine enhanced developmental and vision screening and ensure funding for evidence-based integrated maternal/child services.

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Section: Perinatal and Infant Health Outcomesmentioning

confidence: 99%

Reviewing the Evidence on Prenatal Opioid Exposure to Inform Child Development Policy and Practice

Camden¹,

Harris²,

Otter-Moore³

et al. 2021

hcq

View full text Add to dashboard Cite

show abstract

“…Early life adversity is related to increased risks for developing many behavioral and psychiatric disorders [1]. A spectrum of prenatal, intrapartum, and postnatal episodes is likely to contribute to neurodevelopment via interactions with the individual's genotype to disrupt specific neural and psychophysiological system-related cognitive functions, thereby enhancing the risk for psychopathologies later in life [2,3]. Indeed, children exposed to perinatal opioid drugs appear to have a higher mortality rate after birth and suffer from neurodevelopmental consequences and behavioral problems [4,5].…”

Section: Introductionmentioning

confidence: 99%

Enhanced H3K4 Trimethylation in TNF-α Promoter Gene Locus with Cell Apoptosis in the Ventral-Medial Striatum following Opioid Withdrawal of Neonatal Rat Offspring from Morphine-Addicted Mothers

Suen

Yang

et al. 2021

Mediators of Inflammation

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Prenatal opioid exposure might disturb epigenetic programming in the brain of neonatal offspring with various consequences for gene expressions and behaviors. This study determined whether altered trimethylation of histone 3 at lysine 4 (H3K4me3) in the promoter of the tumor necrosis factor-α (tnf-α) gene with neural cell apoptosis was involved in the ventral-medial striatum, an important brain region for withdrawal symptoms, of neonatal rat offspring from morphine-addicted mothers. Female adult rats were injected with morphine before gestation and until 14 days after giving birth. On postnatal day 14 (P14), rat offspring from morphine-addicted mothers were subjected to an opioid-withdrawal protocol and were analyzed 2 or 8 h after administration of that protocol. Expressions of the TNF-α protein, H3K4me3 in the tnf-α promoter gene, and neural cell apoptosis within the ventral-medial striatum of neonatal rat offspring were evaluated. In the absence of significant opioid withdrawal (2 h after initiation of the opioid-withdrawal protocol on P14), prenatal morphine exposure led to increased levels of H3K4me3 in the tnf-α promoter gene, of the TNF-α protein, and of neural cell apoptosis within the ventral-medial striatum of neonatal rat offspring. Following opioid withdrawal (8 h after initiation of the opioid-withdrawal protocol on P14), differential expression of H3K4me3 in the tnf-α promoter gene locus and upregulation of the level of TNF-α protein expression were further enhanced in these offspring. In addition, increased levels of caspase-3 and neural cell apoptosis were also observed. Taken together, this study revealed that prenatal opioid exposure can activate an epigenetic histone mechanism which regulates proinflammatory factor generation, which hence, led to cell apoptotic damage within the ventral-medial striatum of neonatal rat offspring from morphine-addicted mothers. More importantly, the opioid-withdrawal episode may provide augmented effects for the abovementioned alterations and could lead to deleterious effects in the neonatal brain of such offspring.

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“…Hospital charges due to NAS in the US rose from $190 M in 2000 to $720 M in 2009 [ 3 ]. In addition, for the dyad of mothers with NAS and their infants, maternal mortality is 6.4 times higher and neonatal mortality and/or severe mortality rates are 3.7 times higher than the corresponding rates of dyads without NAS [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis

López-Soto

Griffin

2021

Subst Abuse Treat Prev Policy

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Background Neonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community. Methods We used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana. Results Compared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT). Conclusions Using systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don’t forgo prenatal care for fear of punitive consequences.

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Neonatal Abstinence Syndrome and Associated Neonatal and Maternal Mortality and Morbidity

Cited by 23 publications

References 25 publications

Reviewing the Evidence on Prenatal Opioid Exposure to Inform Child Development Policy and Practice

Reviewing the Evidence on Prenatal Opioid Exposure to Inform Child Development Policy and Practice

Enhanced H3K4 Trimethylation in TNF-α Promoter Gene Locus with Cell Apoptosis in the Ventral-Medial Striatum following Opioid Withdrawal of Neonatal Rat Offspring from Morphine-Addicted Mothers

Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis

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