Dryden C, Young D, Hepburn M, et al.. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources

Neonatal Unit, Princess Royal Maternity, Glasgow, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 03/2009; 116(5):665-71. DOI: 10.1111/j.1471-0528.2008.02073.x
Source: PubMed


The objectives of this study were to investigate factors associated with the development of neonatal abstinence syndrome (NAS) and to assess the implications for healthcare resources of infants born to drug-misusing women.
Retrospective cohort study from 1 January 2004 to 31 December 2006.
Inner-city maternity hospital providing dedicated multidisciplinary care to drug-misusing women.
Four hundred and fifty singleton pregnancies of drug-misusing women prescribed substitute methadone in pregnancy.
Case note review.
Development of NAS and duration of infant hospital stay.
45.5% of infants developed NAS requiring pharmacological treatment. The odds ratio of the infant developing NAS was independently related to prescribed maternal methadone dose rather than associated polydrug misuse. Breastfeeding was associated with reduced odds of requiring treatment for NAS (OR 0.55, 95% CI 0.34-0.88). Preterm birth did not influence the odds of the infant receiving treatment for NAS. 48.4% infants were admitted to the neonatal unit (NNU) 40% of these primarily for treatment of NAS. The median total hospital stay for all infants was 10 days (interquartile range 7-17 days). Infants born to methadone-prescribed drug-misusing mothers represented 2.9% of hospital births, but used 18.2% of NNU cot days.
Higher maternal methadone dose is associated with a higher incidence of NAS. Pregnant drug-misusing women should be encouraged and supported to breastfeed. Their infants are extremely vulnerable and draw heavily on healthcare resources.

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    • "observational studies have found that certain unfavorable neonatal outcomes, such as growth retardation, low birth weight, preterm delivery, and neonatal abstinence syndrome [NAS], were very common (e.g., NAS: 40–75%) among the offspring of women enrolled in the opioid substitute therapy (Burns et al., 2010; Chen et al., 2015; Cleary et al., 2012; Dryden et al., 2009; Hulse et al., 1997, 1998b; Kakko et al., 2008). Relative to infants of non-drug using mothers, the needs in healthcare for children born to women on an opioid substitute therapy are expected to be higher (Johnson et al., 2003; Jones et al., 2010; Kakko et al., 2008), and as such their access to quality and regular well child services is especially important. "
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    • "In four of the studies, length of hospitalization was 3–19 days shorter in breastfed infants [9,38,41,43]. In four of the studies, infants who were breastfed to any extent had up to 30 percent reduction in their need for pharmacologic treatment for NAS [9,38,41,42]. In addition, one study found that predominantly breastfed infants demonstrated signs of withdrawal significantly later than formula-fed infants (10 vs. 3 days; p < 0.001), with decreased Finnegan withdrawal scores in the first 9 days of life [38]. "
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    ABSTRACT: Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach. In addition, most scales were developed prior to the prevalent use of prescribed prenatal concomitant medications, which can complicate NAS assessment. Nonpharmacologic interventions, particularly breastfeeding, may decrease NAS severity. Opioid medications such as morphine or methadone are recommended as first-line therapy, with phenobarbital or clonidine as second-line adjunctive therapy. Further research is needed to determine best practices for assessment, nonpharmacologic intervention, and pharmacologic management of infants with NAS in order to improve outcomes.
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    • "These rates are higher than those found in the present study, with the exception of cocaine (20.6 %). The difference in outcomes between the present study and the study conducted by Dryden et al. (2009) may have been due to the fact that Dryden et al. (2009) measured concomitant drug use for a longer period of time (throughout the entire pregnancy) whereas drug use was assessed only during the last trimester in the present analysis. "
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