The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care

Abstract

As the prescription opioid epidemic grew in the USA, its impact extended to pregnant women and their infants. This review summarises how increasing rates of neonatal abstinence syndrome resulted in a need to improve care to pregnant women and opioid-exposed infants. We discuss the variations in care delivery with particular emphasis on screening at-risk mothers, scoring systems for neonatal drug withdrawal, type and duration of pharmacotherapy, and discharge safety.

Hospital Variation in Neonatal Abstinence Syndrome Incidence, Treatment Modalities, Resource Use, and Costs Across Pediatric Hospitals in the United States, 2013 to 2016

“…A shift toward providing pharmacotherapy outside of the NICU would save both NICU bed days as well as overall bed days and costs while fostering opportunities for rooming-in, breastfeeding, and other nonpharmacologic interventions that have demonstrated improved short-term outcomes. 4,[11][12][13][14][16][17][18] Standardization of pharmacotherapy in terms of duration, location, and choice of treatment also offers an opportunity to reduce use along with duration of opioid exposure. 13,17 This study is limited by the use of administrative data, which may include incomplete data on comorbidities and other clinical factors.…”

“…1 Approaches to treating NAS involve pharmacologic therapy, management without pharmacotherapy, and, more recently, specific nonpharmacologic interventions, with the choice of treatment depending on symptom severity, specific opioid exposure, and institutional or provider variation. [9][10][11][12][13][14] Management without pharmacotherapy includes minimizing stimulation, frequent small volume feeds, and comforting. 15 Nonpharmacologic therapy may involve a number of interventions (including rooming-in, which promotes breastfeeding and maternal attachment) that have shown promising results in reducing the length of stay (LOS) and admission to the NICU, as well as in reducing the need for pharmacologic therapy.…”

Diagnosing uncertainty, producing neonatal abstinence syndrome

“…It was initially popularised in a 1975 article by Finnegan and colleagues (Marcellus ), and is regularly said to be an increasing public health problem, particularly given rising availability of prescription opioids in the United States and Canada (Pryor et al . ). NAS is primarily associated with opioid use during pregnancy, but has been described in babies born to mothers who use a range of psychoactive drugs (including cannabis, amphetamines and benzodiazepines), although reporting is inconsistent (Hudak et al .…”

Langzeitkonsequenzen der intrauterinen Drogenexposition

“…Die vorgenannten Daten wurden durch eine jüngst publizierte Untersuchung zur Opioid-Entzugssymptomatik bestätigt [5]. Weiter zeigen aktuelle Analysen, dass die mediane Behandlungsdauer in den jeweiligen neonatologischen Einheiten zwischen 2004 und 2013 um rund 3 Tage von 13 auf knapp 16 Tage angestiegen ist [6]. Diese Daten beleuchten deutlich den Stellenwert der intrauterinen Exposition für die betroffenen Individuen als auch gesamtgesellschaftlich.…”