Observation and treatment of neonatal narcotic withdrawal

Madden, John D.; Chappel, John N.; Zuspan, Frederick P.; Gumpel, Janis A.; Mejía, Alfonso; Davis, Roy

doi:10.1016/s0002-9378(16)33250-1

Cited by 112 publications

(50 citation statements)

References 7 publications

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“…One simple explanation is that term infants have greater intrauterine methadone exposure (9). Neither measure of total exposure in our study, which included length of exposure and trimester of initial exposure, or those in other studies (13,14) were significant. The association between gestational age and length of treatment is also explained by several biologically plausible mechanisms.…”

Section: Commentcontrasting

confidence: 62%

“…Initiating pharmacologic treatment for NAS decreases the duration of symptoms (2) but does not subjugate the necessity to decrease the severity of withdrawal through antenatal interventions. The majority of literature on methadone administration is concentrated on dosage and the findings regarding an association between maternal methadone dose and the severity of neonatal withdrawal conflict (6,8,9,10,11,12,13,14,15). The optimal dose remains a topic of clinical debate.…”

Section: Introductionmentioning

confidence: 99%

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253: Predicting length of treatment for neonatal abstinence syndrome in methadone exposed neonates

Seligman

Hayes

OʼNeill

et al. 2007

American Journal of Obstetrics and Gynecology

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Section: Commentcontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

253: Predicting length of treatment for neonatal abstinence syndrome in methadone exposed neonates

Seligman

Hayes

OʼNeill

et al. 2007

American Journal of Obstetrics and Gynecology

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“…Between 48 and 94% of infants exposed to opiates in utero develop clinical signs of withdrawal, 4,5 but the effect of polydrug use on the occurrence and severity of neonatal psychomotor behavior remains controversial. (8) Clonidine (2) Clonidine (3) Diazepam (1) Diazepam (2) Variable (6) Methadone (15, 20%)…”

Section: Discussionmentioning

confidence: 99%

Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey

2005

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Aims: To determine the monitoring and treatment of neonatal abstinence syndrome (NAS) in neonatal intensive care units (NICUs) following opiate or polydrug exposure in utero.Methods: A pretested questionnaire was distributed via email to the chiefs of the neonatology divisions with accredited Fellowship programs in Neonatal-Perinatal Medicine in the United States.Results: Of the 102 individuals contacted, 75 participated in the survey. In all, 41 of the respondents (54.5%) have a written policy regarding the management of neonatal NAS. The method of Finnegan is the most commonly used abstinence scoring system (49 of 75, 65%), while only three respondents use the Lipsitz tool. Opioids (tincture of opium, or morphine sulfate solution) are used most commonly for management of both opioid (63% of respondents) and polydrug (52% of respondents) withdrawal, followed by phenobarbital (32 % of respondents) for polydrug withdrawal and methadone (20% of respondents) for opioid withdrawal. In all, 53 respondents (70%) use phenobarbital, and 19 (25%) use intravenous morphine to control opioid withdrawal seizures, while 61 (81%) use phenobarbital in cases of polydrug withdrawal seizures. Only 53 respondents (70%) always use an abstinence scoring system to determine when to start, titrate, or terminate pharmacologic treatment of neonatal NAS. Conclusion:The management of neonatal psychomotor behavior consistent with withdrawal varies widely, with inconsistent policies to determine its presence or treatment. Only about half of NICUs have written guidelines for the management of NAS, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice.

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“…Of these up to 14 comparative studies only 8 stated that treatments were assigned at ran dom [29,32,35,38,39,[42][43][44], Moreover, the methods of randomisation employed in the majority of these 8 studies are not ac cepted as valid today. Observers and raters were not blinded in any of the studies regard ing the type of treatment.…”

Section: Ethodsmentioning

confidence: 99%

Current Management of the Neonatal Abstinence Syndrome: A Critical Analysis of the Evidence

Theis

Selby²,

Ikizler³

et al. 1997

Neonatology

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Objective: To systematically and critically analyse and summarise the published evidence for the rational choice of pharmacologic treatment of the neonatal abstinence syndrome (NAS), a frequently observed condition in neonates born to mothers who are dependent on physically addicting drugs. Design: Studies comparing different pharmacological agents for the treatment of NAS were identified utilising MEDLINE® and additionally the references cited in pertinent articles. The identified studies were critically analysed regarding their study designs and outcome measures. The reported data for the comparative efficacy of the drugs were summarised and evaluated. Results: Fourteen studies were identified, most of them comparing treatment of NAS with phenobarbital, paregoric or diazepam. However, none of these studies was conducted in a double-blind fashion. Frequently, treatment allocations were not properly randomised. Prenatal drug exposure varied and was often not sufficiently verified. Outcome measures and their evaluations differed widely. Due to the different study objectives and flaws in study design, a combined analysis of the published data in the form of a meta-analysis was not deemed possible. When attempting to compare efficacy, diazepam appears to be less efficacious in treating NAS than phenobarbital or paregoric. The relative efficacy of paregoric and phenobarbital appears to depend upon the antenatal exposure of the neonate and on the outcome measure of the study. Only two studies evaluate the efficacy of pure opioids, none of them in direct comparison to paregoric. It remains questionable whether paregoric, which contains the central stimulant camphor and a large amount of alcohol, should be the opioid of choice for the treatment of NAS. Conclusion: Most published studies were conducted prior to the development of clinical epidemiology and modern study design and thus yielded only very limited comparative data on the benefits of different treatment protocols. There is very little evidence regarding the efficacy of different pharmacological therapy regimens to treat NAS. More studies are required to produce the evidence needed to allow a rational choice between treatment modalities of NAS and thus to ensure optimal care of the neonates suffering from this condition.

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Observation and treatment of neonatal narcotic withdrawal

Cited by 112 publications

References 7 publications

253: Predicting length of treatment for neonatal abstinence syndrome in methadone exposed neonates

253: Predicting length of treatment for neonatal abstinence syndrome in methadone exposed neonates

Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey

Current Management of the Neonatal Abstinence Syndrome: A Critical Analysis of the Evidence

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