Relationship between maternal methadone dose at delivery and neonatal abstinence syndrome.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
The Journal of pediatrics (Impact Factor: 4.02). 09/2010; 157(3):428-33, 433.e1. DOI: 10.1016/j.jpeds.2010.03.033
Source: PubMed

ABSTRACT To estimate the relationship between maternal methadone dose and the incidence of neonatal abstinence syndrome (NAS).
We performed a retrospective cohort study of pregnant women treated with methadone for opiate addiction who delivered live-born neonates between 1996 and 2006. Four dose groups, on the basis of total daily methadone dose, were compared (<or=80 mg/d, 81-120 mg/d, 121-160 mg/d, and >160 mg/d). The primary outcome was treatment for NAS. Symptoms of NAS were objectively measured with the Finnegan scoring system, and treatment was initiated for a score>24 during the prior 24 hours.
A total of 330 women treated with methadone and their 388 offspring were included. Average methadone dose at delivery was 117+/-50 mg/d (range, 20-340 mg/d). Overall, 68% of infants were treated for NAS. Of infants exposed to methadone doses<or=80 mg/d, 81-120 mg/d, 121-160 mg/d, and >160 mg/d, treatment for NAS was initiated for 68%, 63%, 70%, and 73% of neonates, respectively (P=.48). The rate of maternal illicit opiate abuse at delivery was 26%, 28%, 19%, and 11%, respectively (P=.04).
No correlation was found between maternal methadone dose and rate of NAS. However, higher doses of methadone were associated with decreased illicit opiate abuse at delivery.

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    ABSTRACT: Background Neonatal abstinence syndrome (NAS) is experienced by infants who were exposed to opioids such as morphine, methadone, codeine, and heroin in utero. The aim of the study was to investigate the effect of laser acupuncture therapy in neonates with NAS due to maternal substitution therapy. Patients and Method This is a prospective, randomised, observer blinded, mono-centric study performed at the division of neonatology at the university teaching hospital, Graz. Laser acu­puncture was performed with a III b laser. Laser acupuncture therapy following a standardised protocol based on the five ear points of the NADA-protocol combined with body acupuncture (Large Intestine 4, Heart 7, Kidney 3, Liver 3), bilaterally. Results Since the start of the pilot study (2008–5/2012) we evaluated 20 neonates with NAS due to maternal substitution therapy. Conclusion Neonates with NAS due to maternal substitution therapy undergoing a combined laser acupuncture therapy of the ear and the body, require a statistically significant shorter oral morphine therapy than neonates with NAS without laser acupuncture therapy (IG = 28,4 days vs. CG = 39,8 days, p < 0,05).
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    ABSTRACT: Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.
    Pediatrics 07/2014; · 5.30 Impact Factor

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