The Impact of Infant Feeding Method on Neonatal Abstinence Scores of Methadone-Exposed Infants

McQueen, Karen; Murphy-Oikonen, Jodie; Gerlach, Keri; Montelpare, William

doi:10.1097/anc.0b013e318225a30c

Cited by 75 publications

(62 citation statements)

References 30 publications

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“…However, two studies in infants exposed to opioids in utero showed that breastfed infants developed less PNA compared to formula fed infants 95,96. The previously mentioned observational study of our research group concluded that breastfeeding is protective for PNA in 247 infants exposed to SSRIs, mirtazapine or venlafaxine in utero.…”

Section: Influential Factorsmentioning

confidence: 60%

The use of psychotropic medication during pregnancy: how about the newborn?

Kieviet¹,

Dolman²,

Honig³

2013

NDT

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Infants are at risk of developing symptoms of Poor Neonatal Adaptation (PNA) after exposure to psychotropic drugs in utero. Such symptoms are largely similar after exposure to antidepressants, antipsychotics and benzodiazepines and consist of mostly mild neurologic, autonomic, respirator and gastro-intestinal abnormalities. Most symptoms develop within 48 hours after birth and last for 2–6 days. After exposure to Selective Serotonin Reuptake Inhibitors (SSRIs), mirtazapine or venlafaxine in utero, breastfeeding is presumably protective for development of PNA. The dosage of antidepressants does not seem to be related to the risk of PNA. In order to objectify possible symptoms of PNA, observation of mother and child at the maternity ward is advisable. If PNA symptoms do not occur, an observation period of 48–72 hours is sufficient. This applies to all types of psychotropic drugs. When PNA symptoms are present it is advisable to observe the infant until the symptoms are fully resolved. Observation can be performed by trained nurses using the Finnegan scoring list. This observation list should be administered every 8 hours. Interpretation of the scores should be carried out by a paediatrician. In most cases symptoms are non-specific. Therefore other diagnoses, such as infection or neurologic problems, have to be excluded. When there is any doubt on possible intoxications during pregnancy, toxicological urine screening is indicated. Most cases of PNA are mild, of short duration and self-limiting without need for treatment. Supporting measures such as frequent small feedings, swaddling and increase of skin to skin contact with the mother is usually sufficient. In case of severe PNA it is advised to admit the infant to the Neonatal Care Unit (NCU). Phenobarbital is a safe therapeutic option. There seem to be no major long term effects; however, additional studies are necessary in order to draw definite conclusions.

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Section: Influential Factorsmentioning

confidence: 60%

The use of psychotropic medication during pregnancy: how about the newborn?

Kieviet¹,

Dolman²,

Honig³

2013

NDT

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“…Methadone levels are very low in breast milk and in infants who are breast-fed. Those results were replicated in a retrospective study of 28 infants, 57 where the NAS scores in breast-fed infants were significantly lower than the scores with formula and combination feedings. In 2006, Abdel-Latif and colleagues 56 reported in their study of 190 infants that breast-feeding decreased the length of treatment of NAS.…”

Section: Feedingmentioning

confidence: 75%

Care of the Infant With Neonatal Abstinence Syndrome

Maguire

2014

Journal of Perinatal &Amp; Neonatal Nursing

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There is little empirical evidence that guides management of infants with neonatal abstinence syndrome. The standard of care first described in the 1970s is still prevalent today, although it has never been tested in this population. Standard of care interventions include decreasing external stimulation, holding, nonnutritive sucking, swaddling, pressure/rubbing, and rocking. These interventions meet the goals of nonpharmacologic interventions, which are to facilitate parental attachment and decrease external stimuli. Many nursing interventions used in infants with neonatal abstinence syndrome have been tested in low-birth-weight infants, whose treatment often includes the same goals. Those interventions include music therapy, kangaroo care, massage, and use of nonoscillating water beds. Nursing attitude has also been shown to be impactful on parental attachment. The American Academy of Pediatrics recommends breast-feeding in infants whose mothers are on methadone who do not have any other contraindication. It also provides guidelines for pharmacologic management but cannot provide specific recommendations about a standard first dose, escalation, or weaning schedule. Buprenorphine has some evidence about its safety in newborns with neonatal abstinence syndrome, but high-powered studies on its efficacy are currently lacking. There are many opportunities for both evidence-based projects and nursing research projects in this population.

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“…Though the amount of opiate being transferred in breast milk is very slight, [43] the possibility of breast milk opiate reducing severity of NAS has been suggested by studies showing that breast milk-fed infants have lower NAS scores than formula-fed infants. [44] …”

Section: Discussionmentioning

confidence: 99%

Can kangaroo care help newborns with neonatal abstinence syndrome? Case report

Ludington‐Hoe¹,

Abouelfettoh²

2015

Clinical Nursing Studies

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Neonatal abstinence syndrome (NAS) is on the rise and NAS newborns are very agitated. Because Kangaroo Care (KC) soothes newborns, we wanted to know what NAS newborns' responses to KC were and how long mothers spontaneously offered KC. A case study design was used and two mother-newborn dyads were recruited by convenience sampling to have Modified Neonatal Abstinence Syndrome Scoring System score and length of KC measured when mothers were with their newborns. Modified Neonatal Abstinence Syndrome Scoring System scores did not decrease with one hour of KC, but did with three or more hours of continuous KC. Medications were regularly administered throughout. One mother provided 60-70 minutes of KC each time and the other mother provided 80 minutes-11 hours of KC. KC may be a supportive therapy for withdrawing newborns.

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The Impact of Infant Feeding Method on Neonatal Abstinence Scores of Methadone-Exposed Infants

Abstract: Breastfeeding may offer enhanced benefits for infants who have been exposed to methadone in utero. As such, in the absence of contraindications, mothers in methadone maintenance programs should be encouraged and supported to breastfeed their infants.

Cited by 75 publications

References 30 publications

The use of psychotropic medication during pregnancy: how about the newborn?

The use of psychotropic medication during pregnancy: how about the newborn?

Care of the Infant With Neonatal Abstinence Syndrome

Can kangaroo care help newborns with neonatal abstinence syndrome? Case report

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