Neonatal Abstinence Syndrome

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Stephen W. Patrick - One of the best experts on this subject based on the ideXlab platform.

  • Neonatal Abstinence Syndrome In The United States, 2004–16
    Health affairs (Project Hope), 2020
    Co-Authors: Ashley A. Leech, Theresa A Scott, William O. Cooper, Elizabeth Mcneer, Stephen W. Patrick
    Abstract:

    After increasing for nearly two decades, rates of Neonatal Abstinence Syndrome have recently leveled off, reaching a plateau as early as 2014. These findings may represent successful efforts to pre...

  • Neonatal Abstinence Syndrome
    Pediatric Clinics of North America, 2019
    Co-Authors: Lauren M. Jansson, Stephen W. Patrick
    Abstract:

    This review examines the continuum of care of opioid-exposed infants, including the assessment of the neonate, diagnosis of Neonatal Abstinence Syndrome, management of the Syndrome including nonpharmacologic and pharmacologic care, approach to breastfeeding, pediatric follow-up care, and integration of care of the mother-infant dyad.

  • The Ecology of Neonatal Abstinence Syndrome
    2019
    Co-Authors: Stephen W. Patrick, Laura J. Faherty, Andrew W. Dick, Theresa A Scott, Judith A. Dudley, Bradley D. Stein
    Abstract:

    Newborns exposed to opioids before birth can experience withdrawal symptoms known as Neonatal Abstinence Syndrome (NAS). From 2009 to 2015, the average NAS rate per 1,000 hospital births across eight states rose from about six to more than 25.

  • Neonatal Abstinence Syndrome
    Nature reviews. Disease primers, 2018
    Co-Authors: Mara G. Coyle, Susan B. Brogly, Mahmoud S. Ahmed, Stephen W. Patrick, Hendrée E. Jones
    Abstract:

    Neonatal Abstinence Syndrome refers to the signs and symptoms attributed to the cessation of prenatal exposure (via placental transfer) to various substances. This Primer focuses on Neonatal Abstinence Syndrome caused by opioid use during pregnancy — Neonatal opioid withdrawal Syndrome (NOWS). As the global prevalence of opioid use has alarmingly increased, so has the incidence of NOWS. NOWS can manifest with varying severity or not at all, for unknown reasons, but is likely to be associated with multiple factors, both maternal (for example, smoking and additional substance exposures) and Neonatal (gestational age, sex and genetics). Care for the infant with NOWS begins with addressing the issues experienced by pregnant women with opioid use disorder. Co-occurring mental illness, economic hardship, intimate partner violence, infectious diseases and limited access to care are common in these women and can result in poor maternal and Neonatal outcomes. Although there is no consensus regarding optimal NOWS management, non-pharmacological interventions (such as breastfeeding and rooming-in of the mother and the baby) have become a priority, as they can ameliorate symptoms without the need for further opioid exposure. Untreated NOWS can be associated with morbidity in early infancy, and the long-term consequences of fetal opioid exposure are only beginning to be understood. Neonatal Abstinence Syndrome refers to the signs and symptoms in a neonate that are caused by the cessation of prenatal exposure (via placental transfer) to various substances. In particular, opioid use or misuse during pregnancy can lead to Neonatal opioid withdrawal Syndrome.

  • Neonatal Abstinence Syndrome: an update
    Current opinion in pediatrics, 2018
    Co-Authors: Lauren A. Sanlorenzo, Ann R. Stark, Stephen W. Patrick
    Abstract:

    Purpose of reviewThe current review provides an update focused on the evolving epidemiology of Neonatal Abstinence Syndrome (NAS), factors influencing disease expression, advances in clinical assessment of withdrawal, novel approaches to NAS treatment, and the emerging role of quality improvement in

Gil Klinger - One of the best experts on this subject based on the ideXlab platform.

  • Long-term outcome following selective serotonin reuptake inhibitor induced Neonatal Abstinence Syndrome.
    Journal of perinatology : official journal of the California Perinatal Association, 2011
    Co-Authors: Gil Klinger, D Frankenthal, Paul Merlob, G Diamond, Lea Sirota, Rachel Levinson-castiel, Nehama Linder, Bracha Stahl, D Inbar
    Abstract:

    Long-term outcome following selective serotonin reuptake inhibitor induced Neonatal Abstinence Syndrome

  • Neonatal Abstinence Syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants
    JAMA Pediatrics, 2006
    Co-Authors: Rachel Levinsoncastiel, Lea Sirota, Paul Merlob, Nehama Linder, Gil Klinger
    Abstract:

    Objective To compare the prevalence and clinical characteristics of Neonatal Abstinence Syndrome in neonates exposed and not exposed to selective serotonin reuptake inhibitors (SSRIs) in utero. Design Cohort study. Setting Tertiary care center. Patients One hundred twenty term infants, of whom 60 had prolonged in utero exposure to SSRIs, including paroxetine hydrochloride, fluoxetine, citalopram hydrobromide, sertraline hydrochloride, and venlafaxine hydrochloride. Main Outcome Measures Neonatal Abstinence Syndrome was assessed with the Finnegan score as follows: score of 8 or above, severe; score of 4 to 7, mild; and score of 0 to 3, normal. All infants were followed up with a standardized protocol that included repeated Finnegan score assessments and cardiorespiratory monitoring until normalization of the Finnegan score. Results Of the 60 neonates exposed to SSRIs in utero, 8 showed severe and 10 showed mild symptoms of a Neonatal Abstinence Syndrome. All nonexposed neonates had a normal Finnegan score. In neonates who developed severe symptoms, the maximum mean daily Finnegan scores were recorded within 2 days after birth, although maximum individual scores were recorded as long as 4 days after birth. Conclusions Neonatal Abstinence Syndrome occurs in 30% of neonates exposed to SSRIs in utero. These neonates should be monitored for at least 48 hours after birth. The long-term effects of prolonged exposure to SSRIs, particularly in neonates who develop severe symptoms, have yet to be determined.

Walter K. Kraft - One of the best experts on this subject based on the ideXlab platform.

  • Buprenorphine in Neonatal Abstinence Syndrome.
    Clinical pharmacology and therapeutics, 2017
    Co-Authors: Walter K. Kraft
    Abstract:

    Infants exposed in utero to opioids will demonstrate a withdrawal Syndrome known as Neonatal Abstinence Syndrome (NAS). Buprenorphine is a long-acting opioid with therapeutic use in medication-assisted treatment of opioid dependency in adults and adolescents. Emerging data from clinical trials and treatment cohorts demonstrate the efficacy and safety of sublingual buprenorphine for those infants with NAS who require pharmacologic treatment. Pharmacometric modeling will assist in defining the exposure-response relationships and facilitate dose optimization.

  • buprenorphine for the treatment of the Neonatal Abstinence Syndrome
    The New England Journal of Medicine, 2017
    Co-Authors: Walter K. Kraft, Karol Kaltenbach, Susan C Adeniyijones, Inna Chervoneva, Jay S Greenspan, Diane J Abatemarco, Michelle E Ehrlich
    Abstract:

    BackgroundCurrent pharmacologic treatment of the Neonatal Abstinence Syndrome with morphine is associated with a lengthy duration of therapy and hospitalization. Buprenorphine may be more effective than morphine for this indication. MethodsIn this single-site, double-blind, double-dummy clinical trial, we randomly assigned 63 term infants (≥37 weeks of gestation) who had been exposed to opioids in utero and who had signs of the Neonatal Abstinence Syndrome to receive either sublingual buprenorphine or oral morphine. Infants with symptoms that were not controlled with the maximum dose of opioid were treated with adjunctive phenobarbital. The primary end point was the duration of treatment for symptoms of Neonatal opioid withdrawal. Secondary clinical end points were the length of hospital stay, the percentage of infants who required supplemental treatment with phenobarbital, and safety. ResultsThe median duration of treatment was significantly shorter with buprenorphine than with morphine (15 days vs. 28 d...

  • Pharmacologic management of the opioid Neonatal Abstinence Syndrome.
    Pediatric clinics of North America, 2012
    Co-Authors: Walter K. Kraft, John Van Den Anker
    Abstract:

    Opioid use in pregnant women has increased over the last decade. Following birth, infants with in utero exposure demonstrate signs and symptoms of withdrawal known as the Neonatal Abstinence Syndrome (NAS). Infants express a spectrum of disease, with most requiring the administration of pharmacologic therapy to ensure proper growth and development. Treatment often involves prolonged hospitalization. There is a general lack of high-quality clinical trial data to guide optimal therapy, and significant heterogeneity in treatment approaches. Emerging trends in the treatment of infants with NAS include the use of sublingual buprenorphine, transition to outpatient therapy, and pharmacogenetic risk stratification.

  • Sublingual buprenorphine for treatment of Neonatal Abstinence Syndrome: a randomized trial.
    Pediatrics, 2008
    Co-Authors: Walter K. Kraft, Karol Kaltenbach, Jay S Greenspan, Eric Gibson, Kevin Dysart, Vidula S. Damle, Jennifer Larusso, David E. Moody, Michelle E Ehrlich
    Abstract:

    OBJECTIVE. In utero exposure to drugs of abuse can lead to Neonatal Abstinence Syndrome, a condition that is associated with prolonged hospitalization. Buprenorphine is a partial μ-opioid agonist used for treatment of adult detoxification and maintenance but has never been administered to neonates with opioid Abstinence Syndrome. The primary objective of this study was to demonstrate the feasibility and, to the extent possible in this size of study, the safety of sublingual buprenorphine in the treatment of Neonatal Abstinence Syndrome. Secondary goals were to evaluate efficacy relative to standard therapy and to characterize buprenorphine pharmacokinetics when sublingually administered. METHODS. We conducted a randomized, open-label, active-control study of sublingual buprenorphine for the treatment of opiate withdrawal. Thirteen term infants were allocated to receive sublingual buprenorphine 13.2 to 39.0 μg/kg per day administered in 3 divided doses and 13 to receive standard-of-care oral Neonatal opium solution. Dose decisions were made by using a modified Finnegan scoring system. RESULTS. Sublingual buprenorphine was largely effective in controlling Neonatal Abstinence Syndrome. Greater than 98% of plasma concentrations ranged from undetectable to ∼0.60 ng/mL, which is less than needed to control Abstinence symptoms in adults. The ratio of buprenorphine to norbuprenorphine was larger than that seen in adults, suggesting a relative impairment of N-dealkylation. Three infants who received buprenorphine and 1 infant who received standard of care reached protocol-specified maximum doses and required adjuvant therapy with phenobarbital. The mean length of treatment for those in the Neonatal-opium-solution group was 32 compared with 22 days for the buprenorphine group. The mean length of stay for the Neonatal-opium-solution group was 38 days compared with 27 days for those in the buprenorphine group. Treatment with buprenorphine was well tolerated. CONCLUSIONS. Buprenorphine administered via the sublingual route is feasible and apparently safe and may represent a novel treatment for Neonatal Abstinence Syndrome.

Leandro Cordero - One of the best experts on this subject based on the ideXlab platform.

Brian J Cleary - One of the best experts on this subject based on the ideXlab platform.

  • methadone dose and Neonatal Abstinence Syndrome systematic review and meta analysis
    Addiction, 2010
    Co-Authors: Brian J Cleary, Jean Donnelly, Judith Strawbridge, Paul J Gallagher, Tom Fahey, Mike Clarke, Deirdre J Murphy
    Abstract:

    Aim: To determine if there is a relationship between maternal methadone dose in pregnancy and the diagnosis or medical treatment of Neonatal Abstinence Syndrome (NAS). Methods PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966–2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut-off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta-analysis. Sensitivity analyses explored the impact of limiting meta-analyses to prospective studies or studies using an objective scoring system to diagnose NAS. Results A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta-analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non-significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. Conclusions: Severity of the Neonatal Abstinence Syndrome does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy.

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