Neonatal Visual Evoked Potentials in Infants Born to Mothers Prescribed Methadone

McGlone, Laura; Hamilton, Ruth; McCulloch, Daphne L.; Boulton, Richard G.; Bradnam, Michael S.; Weaver, Lawrence T.; Mactier, Helen

doi:10.1542/peds.2012-2113

Cited by 46 publications

(68 citation statements)

References 25 publications

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“…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%

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%

Neonatal Abstinence Syndrome

2014

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“…5,9 The health of children after prenatal opioid exposure is thus unclear. Opioids may interfere with neurologic development, resulting in physiologic, 10 psychological, 11 and behavioral 11 dysfunction up to adolescence. 11 The addition of environmental stress, due to chaotic home environments, parental dysfunction, and economic deprivation such as poverty and malnutrition may further affect child health and development, 12,13 which in turn could lead to future and more serious adult outcomes, even until old age.…”

Section: What Our Study Addsmentioning

confidence: 99%

Reasons for Rehospitalization in Children Who Had Neonatal Abstinence Syndrome

Uebel

Wright

Burns³

et al. 2015

Pediatrics

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“…Abnormalities of cortical visual function persist at least to 6 months of age in term babies born to methadone-maintained mothers and up to 40% of these babies fail clinical visual assessment, with a very high incidence of nystagmus [16]. Interestingly, abnormalities of visual function in the first year of life do not seem to be related to manifestation of NAS, raising issues concerning arrangements for follow-up of these vulnerable children [13,16].Opioid-dependent pregnancies are more likely to result in preterm birth, but we currently lack a well-validated assessment tool for NAS in this population. All babies born to opioid-dependent mothers should be considered at risk of longer-term visual, behavioural and neurodevelopmental problems and should be followed-up, regardless of manifestations of NAS in the newborn period.…”

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confidence: 99%

“…Increasing evidence points to adverse effects of opioid exposure upon the developing brain, with disproportionately small head circumference at birth and abnormal cortical visual evoked potentials [11][12][13]. Preliminary magnetic resonance imaging (MRI) data indicate reduced brain volume in term opioid-exposed babies [14].…”

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Commentary on Gibson et al. (2017): Gestational age and the severity of neonatal abstinence syndrome

Mactier

2017

Addiction

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Commentary on Gibson et al. (2017): Gestational age and the severity of neonatal abstinence syndrome Neonatal abstinence is difficult to assess in preterm infants, and the pros and cons of opioid replacement treatment are not clear. Clinicians should be aware of potential longer term issues for in-utero opioid-exposed children, regardless of neonatal manifestations.Gibson et al.'s retrospective study highlights an important issue, and adds to the debate around whether preterm infants are as likely as their term-born compatriots to develop significant neonatal abstinence syndrome (NAS) following in-utero opioid exposure [1][2][3]. In a large cohort (n = 102) of late preterm infants (gestational ages 34-36 weeks), the likelihood of receiving pharmacological treatment for NAS was not different compared to babies born at later gestations. These data are of particular interest in light of recent rises not only in the number of illicit opioid using mothers, but also in mothers on prescribed opioids, and indicate that concerns regarding the development of NAS following maternal opioid use in pregnancy should not influence timing of delivery [4,5].Although initiation of opioid replacement therapy was not influenced by gestation, median duration of treatment for late preterm infants was significantly shorter (by approximately 30%) compared to infants born at term. The authors postulate that this may be due to differences in placental opioid transport related either to gestation or concomitant illicit drug use, reduced cumulative opioid exposure, slower postnatal opioid excretion, neurological immaturity or a combination of factors [1,6]. In common with many other workers, Gibson et al. described use of a modified Finnegan score to assess the severity of NAS, but carers should be aware that no scoring system is well validated in the preterm population. A recent study compared preterm babies born at gestations ranging from 33 to 36 weeks with babies born at term, and noted gestation-related changes in a variety of Finnegan scoring criteria, some of which (e.g. tachypnoea) would increase, and some of which (including sleep disturbance and sweating) would decrease the cumulative Finnegan score [7]. NAS is ameliorated by rooming-in as well as by breast feeding [8]; in Gibson's study late preterm infants were more likely to be admitted to the neonatal unit, which may have occasioned closer observation and documentation of milder signs of NAS. None of the mothers of the late preterm infants was homeless, which may have been associated with a less unstable life-style and less illicit drug use, but numbers were small. There was no significant interaction between maternal maintenance treatment, gestational age and the likelihood of the baby receiving treatment for NAS, but only a small proportion of mothers in Gibson's study had been maintained on buprenorphine, and so there may be a type II error. Less severe NAS has been described by others for babies born to buprenorphine, compared to methadone-maintained mothers [9,10].Opioid ...

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Neonatal Visual Evoked Potentials in Infants Born to Mothers Prescribed Methadone

Abstract: In utero exposure to prescribed substitute methadone is associated with altered flash VEPs in the newborn period and these infants may warrant early clinical visual assessment.

Cited by 46 publications

References 25 publications

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome

Reasons for Rehospitalization in Children Who Had Neonatal Abstinence Syndrome

Commentary on Gibson et al. (2017): Gestational age and the severity of neonatal abstinence syndrome

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