Pharmacologic Management of the Opioid Neonatal Abstinence Syndrome

Overview

Journal Pediatr Clin North Am

Specialty Pediatrics

Date 2012 Oct 6

PMID 23036249

Citations 21

Authors

Walter K Kraft

John N van den Anker

Affiliations

Soon will be listed here.

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.

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References

Oschman A, McCabe T, Kuhn R . Dexmedetomidine for opioid and benzodiazepine withdrawal in pediatric patients. Am J Health Syst Pharm. 2011; 68(13):1233-8. DOI: 10.2146/ajhp100257. View

Lester B, Lagasse L . Children of addicted women. J Addict Dis. 2010; 29(2):259-76. PMC: 4451952. DOI: 10.1080/10550881003684921. View

Jansson L, Velez M . Neonatal abstinence syndrome. Curr Opin Pediatr. 2012; 24(2):252-8. DOI: 10.1097/MOP.0b013e32834fdc3a. View

Jansson L . Neonatal abstinence syndrome. Acta Paediatr. 2008; 97(10):1321-3. DOI: 10.1111/j.1651-2227.2008.00968.x. View

Koren G, Matsui D, Einarson A, Knoppert D, Steiner M . Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates?. CMAJ. 2005; 172(11):1457-9. PMC: 557982. DOI: 10.1503/cmaj.1041100. View

Choo R, Huestis M, Schroeder J, Shin A, Jones H . Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure. Drug Alcohol Depend. 2004; 75(3):253-60. DOI: 10.1016/j.drugalcdep.2004.03.012. View

Jansson L, DiPietro J, Elko A, Velez M . Infant autonomic functioning and neonatal abstinence syndrome. Drug Alcohol Depend. 2010; 109(1-3):198-204. PMC: 2875284. DOI: 10.1016/j.drugalcdep.2010.01.004. View

Finnegan L, Michael H, Leifer B . The use of phenobarbital in treating abstinence in newborns exposed in utero to psychoactive agents. NIDA Res Monogr. 1984; 49:329. View

McCarthy J, Siney C, Shaw N, Ruben S . Outcome predictors in pregnant opiate and polydrug users. Eur J Pediatr. 1999; 158(9):748-9. DOI: 10.1007/s004310051193. View

10.

Mass S . Supporting breastfeeding in the United States: the Surgeon General's call to action. Curr Opin Obstet Gynecol. 2011; 23(6):460-4. DOI: 10.1097/GCO.0b013e32834cdcb3. View

11.

van Sleuwen B, Engelberts A, Boere-Boonekamp M, Kuis W, Schulpen T, LHoir M . Swaddling: a systematic review. Pediatrics. 2007; 120(4):e1097-106. DOI: 10.1542/peds.2006-2083. View

12.

Wikner B, Stiller C, Kallen B, Asker C . Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: maternal characteristics. Pharmacoepidemiol Drug Saf. 2007; 16(9):988-94. DOI: 10.1002/pds.1391. View

13.

Messinger D, Bauer C, Das A, Seifer R, Lester B, Lagasse L . The maternal lifestyle study: cognitive, motor, and behavioral outcomes of cocaine-exposed and opiate-exposed infants through three years of age. Pediatrics. 2004; 113(6):1677-85. DOI: 10.1542/peds.113.6.1677. View

14.

Unger A, Jagsch R, Bawert A, Winklbaur B, Rohrmeister K, Martin P . Are male neonates more vulnerable to neonatal abstinence syndrome than female neonates?. Gend Med. 2011; 8(6):355-64. PMC: 3241965. DOI: 10.1016/j.genm.2011.10.001. View

15.

Lindemalm S, Nydert P, Svensson J, Stahle L, Sarman I . Transfer of buprenorphine into breast milk and calculation of infant drug dose. J Hum Lact. 2009; 25(2):199-205. DOI: 10.1177/0890334408328295. View

16.

Swortfiguer D, Cissoko H, Giraudeau B, Jonville-Bera A, Bensouda L, Autret-Leca E . [Neonatal consequences of benzodiazepines used during the last month of pregnancy]. Arch Pediatr. 2005; 12(9):1327-31. DOI: 10.1016/j.arcped.2005.03.055. View

17.

de Cock R, Piana C, Krekels E, Danhof M, Allegaert K, Knibbe C . The role of population PK-PD modelling in paediatric clinical research. Eur J Clin Pharmacol. 2010; 67 Suppl 1:5-16. PMC: 3082690. DOI: 10.1007/s00228-009-0782-9. View

18.

Pitlick W, Painter M, Pippenger C . Phenobarbital pharmacokinetics in neonates. Clin Pharmacol Ther. 1978; 23(3):346-50. DOI: 10.1002/cpt1978233346. View

19.

Gowing L, Farrell M, Ali R, White J . Alpha2 adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst Rev. 2001; (1):CD002024. DOI: 10.1002/14651858.CD002024. View

20.

Hunt R, Tzioumi D, Collins E, Jeffery H . Adverse neurodevelopmental outcome of infants exposed to opiate in-utero. Early Hum Dev. 2007; 84(1):29-35. DOI: 10.1016/j.earlhumdev.2007.01.013. View