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Chapter 14 - Neonatal Abstinence Syndrome

from Section 4 - The Newborn

Published online by Cambridge University Press:  08 June 2018

By
Karol Kaltenbach  and
Loretta Finnegan
Edited by
Tricia E. Wright
Tricia E. Wright
Affiliation:
University of Hawaii, Manoa
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Opioid-Use Disorders in Pregnancy
Management Guidelines for Improving Outcomes
 , pp. 113 - 126
Publisher: Cambridge University Press
Print publication year: 2018

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References

Heroin Timeline. Heroin addiction. Available at: www.heroinaddiction.com/heroin_timeline.html. Accessed October 12, 2013.Google Scholar
Merry, J. A social history of heroin addiction. Br J Addict Alcohol Other Drugs 1975; 70(3):307–10.Google ScholarPubMed
Courtwright, D. Dark Paradise: Opiate Addiction in America Before 1940. Cambridge, MA: Harvard University Press; 1982.Google Scholar
Menninger-Lerchenthal, E. Die morphin kranheit der neugeborenen morphine stischer mutter Monatsschr. F Kinderh 1934; 60:182–93.Google Scholar
Happel, T. J. Morphinism in its relation to the sexual functions and appetite and its effects on the offspring of the users of the drug. Tr M Soc Tennessee 1892;162–79.Google Scholar
Earle, F. B. Maternal opium habit and infant mortality. Med Standard (Chicago) 1888; 3:2.Google Scholar
OD. Fetal morphine addiction, queries and minor notes. JAMA 1903; 40:1092.Google Scholar
Perlstein, M. A. Congenital morphinism: A rare cause of convulsions in the newborn. J Am Med Assoc 1947;135(10):633.Google Scholar
Goodfriend, M. J., Shey, I. A., Klein, M. D. The effects of maternal narcotic addiction on the newborn. Am J Obstet Gynecol 1956; 71(1):29–36.CrossRefGoogle ScholarPubMed
Cobrinik, R. W., Hood, R. T. Jr, Chusid, E. The effect of maternal narcotic addiction on the newborn infant; review of literature and report of 22 cases. Pediatrics 1959; 24(2):288–304.CrossRefGoogle Scholar
National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. Effective medical treatment of opiate addiction. JAMA 1998; 280(22):1936–43.Google Scholar
Reddy, A. M., Harper, R. G., Stern, G. Observations on heroin and methadone withdrawal in the newborn. Pediatrics 1971; 48(3):353–8.CrossRefGoogle ScholarPubMed
Blinick, G., Jerez, E., Wallach, R. C. Methadone maintenance, pregnancy, and progeny. J Am Med Assoc 1973; 225:477–9.CrossRefGoogle ScholarPubMed
Zelson, C., Rubio, E., Wasserman, E. Neonatal narcotic addiction: 10-year observation. Pediatrics 1971; 48:178.Google Scholar
Finnegan, L. P., Kron, R. E., Connoughton, J. F., Emich, J. P. A Scoring System for Evaluation and Treatment of the Neonatal Abstinence Syndrome: A New Clinical and Research Tool. In Morselli, P. I., Sereni, F., editors. Basic and Therapeutic Aspects of Perinatal Pharmacology. New York: Raven Press; 1975, pp. 139–53.Google Scholar
Lipsitz, P. J. A proposed narcotic withdrawal score for use with newborn infants. Clin Pediatr 1975; 14(6):592–4.CrossRefGoogle ScholarPubMed
Auriacombe, M., Fatséas, M., Dubernet, J., Daulouède, J. P., Tignol, J. French field experience with buprenorphine. Am J Addict 2004; 13(suppl 1):S17–S28.CrossRefGoogle ScholarPubMed
Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. Rockville, MD: Substance Abuse and Mental Health Administration; 2004. DHHS publication (SMA) 04-3939.Google Scholar
Marquet, P., Chevrel, J., Lavignasse, P., Merle, L., Lachâtre, G. Buprenorphine withdrawal syndrome in a newborn. Clin Pharmacol Ther 1997; 62(5):569–71.CrossRefGoogle ScholarPubMed
Kayemba-Kay's, S., Laclyde, J. P. Buprenorphine withdrawal syndrome in newborns: A report of 13 cases. Addiction 2003; 98(11):1599–604.Google ScholarPubMed
Rao, R., Desai, N. S. Oxycontin and neonatal abstinence syndrome. J Perinatol. 2002; 22(4):324–5.Google Scholar
Jansson, L. M. Neonatal abstinence syndrome. www.uptodate.com. Accessed December 16.Google Scholar
McCarthy, J. J., Leamon, M. H., Willits, N. H., Salo, R. The effects of methadone dose regimen on neonatal abstinence syndrome. J Addict Med 2015; 9:105–10.CrossRefGoogle ScholarPubMed
Kaltenbach, K., Jones, H. J. Neonatal abstinence syndrome: Presentation and treatment considerations. J Addict Med 2016; 10(4):217–33.Google Scholar
Patrick, S. W., Schumacher, R. E., Bennyworth, B. D., et al. Neonatal abstinence syndrome and associated health care expenditures. JAMA 2012; 307(18):1934–40.Google Scholar
Ko, J. Y., Patrick, S. W., Tong, V. T., et al. Incidence of neonatal abstinence syndrome – 28 states, 1999–2013. MMWR 2016; 65(31):799–802.Google Scholar
Patrick, S. W., Davis, M. M., Lehmann, C. U., Cooper, W. O. Increasing incidence and geographical distribution of neonatal abstinence syndrome: United States 2009–2012. J Perinatol 2015; 35:650–5.Google Scholar
Vallapiano, N. L. G., Winkleman, T. N. A., Kozhimannil, K. B., Davis, M. M., Patrick, S. W. Rural and urban differences in neonatal abstinence syndrome and maternal opioid use, 2004–2013. JAMA Pediatr 2016; doi: 10.1001/jamapediatrics.2016.3750.Google Scholar
Finnegan, L. P., Kandall, S. R. Neonatal abstinence syndromes. In Aranda, J., Jaffe, S. J., editors. Neonatal and Pediatric Pharmacology: Therapeutic Principles in Practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2005.Google Scholar
Gillogley, K. M., Evans, A. T., Hansen, R. L., Samuels, S. J., Batra, K. K. The perinatal impact of cocaine, amphetamine, and opiate use detected by universal intrapartum screening. Am J Obstet Gynecol 1990; 163:1535–42.Google Scholar
Connaughton, J. F., Reeser, D., Schut, J., Finnegan, L. P. Perinatal addiction: Outcome and management. Am J Obstet Gynecol 1977; 129:679–86.Google Scholar
Rorke, L. B., Reeser, D. S., Finnegan, L. P. Nervous system lesions in infants of opiate dependent mothers. Pediatr Res 1977; 11:565.CrossRefGoogle Scholar
Holbrook, A. M., Baxter, J. K., Jones, H. E., et al. Infections and obstetrical outcomes in opioid-dependent pregnant women maintained on methadone or buprenorphine. Addiction 2012; 107(Suppl. 1):83–90.CrossRefGoogle ScholarPubMed
Finnegan, L. P., Hagan, T., Kaltenbach, K. Opioid dependence: Scientific foundations for clinical practice, pregnancy and substance abuse: Perspectives and directions. Bull N Y Acad Med 1991; 67(3):223–9.Google Scholar
Hudak, M. L., Tan, R. C. Committee on drugs; committee on fetus and newborn American academy of pediatrics clinical report. Neonatal drug withdrawal. Pediatrics 2012; 129(2):e540–60.Google Scholar
Kaltenbach, K., Holbrook, A., Coyle, M., et al. Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication. Addiction 2012; 107(Suppl. 1):45–52.CrossRefGoogle ScholarPubMed
Jansson, L. M., Diepietro, J. A., Elko, A., Velez, M. Infant autonomic functioning and neonatal abstinence. Drug Alcohol Depend 2010; 109:198–204.CrossRefGoogle ScholarPubMed
Seligman, N. S., Salva, N., Hayes, E. J., et al. Predicting length of treatment for neonatal abstinence syndrome in methadone exposed infants. Am J Obstet Gynecol 2008; 396:e1–7.Google Scholar
Dryden, C., Young, D., Hepburn, M., Mactier, H. Maternal methadone use in pregnancy: Factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. Br J Obstet Gynecol 2009; 116(5):665–71.Google Scholar
Wachman, E. M., Newby, P. K., Vreeland, J., et al. The relationship between maternal opioid agonists and psychiatric medications on length of hospitalization for neonatal abstinence. J Addict Med 2011; 5(4):293–9.CrossRefGoogle ScholarPubMed
Pritham, U. A., Paul, J. A., Hayes, M. J. Opioid dependency in pregnancy and length of stay for neonatal abstinence syndrome. J Obstet Gynecol Neonatal Nurs 2012; 41(20):180–90.CrossRefGoogle ScholarPubMed
Choo, R. E., Huestis, M. A., Schroeder, J. R., Shin, A. S., Jones, H. E. Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure. Drug Alcohol Depend 2004; 75:253–60.Google Scholar
Jones, H. E., Heil, S. H., Tuten, M., et al. Cigarette smoking in opioid dependent pregnant women: Neonatal and maternal outcomes. Drug Alcohol Depend 2013; 131(3):271–7.Google Scholar
Gibson, K. S., Starks, S., Kumar, D., Bailit, J. L. Relationship between gestational age and the severity of neonatal abstinence syndrome. Addiction 2017; 112(4):711–6.CrossRefGoogle ScholarPubMed
Doberczak, T. M., Kandall, S. R., Wilets, I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr 1991; 118:933–7.CrossRefGoogle ScholarPubMed
Ruwanpathirana, R., Abedel-Latif, M. E., Burns, L., et al. Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome. Acta Paediatr 2015; 104:e188–e94.Google Scholar
Dysart, K., Hsieh, H., Kaltenbach, K., Greenspan, J. S. Sequela of preterm versus term infants born to mothers on a methadone maintenance program: Differential course of neonatal abstinence syndrome. J Perinat Med 2007; 35:344–6.Google Scholar
Jones, H. E., Kaltenbach, K., Heil, S. H., et al., Neonatal abstinence syndrome after methadone or buprenorphine exposure. NEJM 2010; 363:2320–31.Google Scholar
Gaalema, D. E., Scott, T. L., Heil, S. H., et al. Differences in the profile of neonatal abstinence syndrome signs in methadone versus buprenorphine-exposed infants. Addiction 2012; 107(Suppl.):53–62.Google Scholar
Unger, A., Jagsch, R., Bawert, A., et al. Are male neonates more vulnerable to neonatal abstinence syndrome than female neonates? Gender Medicine 2011; 8(6):355–64.CrossRefGoogle ScholarPubMed
Holbrook, A., Kaltenbach, K. Gender and NAS: Does sex matter? Drug Alcohol Depend 2010; 112(1–2):156–9.Google Scholar
Wachman, E. M., Hayes, M. J., Brown, M. S., et al. Association of OPRM1 and COMT single-nucleotide polymorphisms with hospital length of stay and treatment of neonatal abstinence syndrome. JAMA 2013; 309(17):1821–7.Google Scholar
Wachman, E. M., Hayes, M. J., Lester, B. M., et al. Epigenetic variation in the mu-opioid receptor gene in infants with neonatal abstinence syndrome. J Pediatr 2014; 165(3):472–8.Google Scholar
Wachman, E. M., Hayes, M. J., Sherva, R., et al. Variations in opioid receptor genes in neonatal abstinence syndrome. Drug Alcohol Depend 2015; 155:253–9.CrossRefGoogle ScholarPubMed
Cleary, B. J., Donelly, J., Strawbridge, J., et al. Methadone dose and neonatal abstinence syndrome – Systematic review and meta-analysis. Addiction 2010; 105:2071–84.CrossRefGoogle ScholarPubMed
Jones, H. E., Jansson, L. M., O'Grady, K. E., Kaltenbach, K. The relationship between maternal methadone dose at delivery and neonatal outcomes: Methodological and design considerations. Neurotoxicol Teratol 2013; 39:110–5.CrossRefGoogle ScholarPubMed
Jones, H. E., Dengler, E., Garrison, A., et al. Neonatal outcomes and their relationship to buprenorphine dose during pregnancy. Drug Alcohol Depend 2014; 134:414–47.Google Scholar
Brogly, S. B., Saia, K. A., Walley, A. Y., Du, H. M., Sebastian, P. Prenatal buprenorphine versus methadone exposure and neonatal abstinence syndrome: Systematic review and meta-analysis. Am J Epidemol 2014; 180:673–86.Google Scholar
Jones, H. E., Finnegan, L. P., Kaltenbach, K. Methadone and buprenorphine for the management of opioid dependence in pregnancy. Drugs 2012; 72(6):747–57.CrossRefGoogle ScholarPubMed
Finnegan, L. P. Neonatal abstinence syndrome: Assessment and pharmacotherapy. In Rubaltelli, F. F., Granati, B., editors. Neonatal Therapy: An Update. New York: Elsevier; 1986, pp. 122–46.Google Scholar
Kron, R. E., Litt, M., Phoenix, M. D., Finnegan, L. P. Neonatal narcotic abstinence: Effects of pharmacotherapeutic agents and maternal drug usage on nutritive sucking behavior. J Pediatr 1976; 88:637–41.Google Scholar
Herzlinger, R. A., Kandall, S. R., Vaughan, H. G. Neonatal seizures associated with narcotic withdrawal. J Pediatr 1977; 91:638–41.CrossRefGoogle ScholarPubMed
Kandall, S. R., Doberczak, T. M., Mauer, K. R., Strashun, R. H., Korts, D. C. Opiate v CNS depressant therapy in neonatal drug abstinence syndrome. Am J Dis Child 1983; 137:378–82.Google Scholar
Weinberger, S. M., Kandall, S. R., Doberczak, T. M., Thornton, J. C., Bernstein, J. Early weight-change patterns in neonatal abstinence. Am J Dis Child 1986; 140:829–32.Google Scholar
Finnegan, L. P. Pulmonary problems encountered by the infant of the drug-dependent mother. Clin Chest Med 1980; 1:311–25.Google Scholar
Finnegan, L. P. Influence of maternal drug dependence on the newborn. In Kacew, S., Lock, S., editors. Toxicologic and Pharmacologic Principles in Pediatrics. Washington, DC: Hemisphere; 1988.Google Scholar
Glass, L., Rajegowda, B. K., Kahn, E. J., Floyd, M. V. Effect of heroin on respiratory rate and acid–base status in the newborn. N Engl J Med 1972; 286:746–8.Google Scholar
Behrendt, H., Green, M. Nature of the sweating deficit of prematurely born neonates. N Engl J Med 1972; 286:1376–9.CrossRefGoogle ScholarPubMed
NIDA Services Research Monograph Series. Drug Dependence in Pregnancy: Clinical Management of Mother and Child, Loretta Finnegan, Ed. ADAMHA, 1979.Google Scholar
Himmelsbach, C. K. The morphine abstinence syndrome, its nature and treatment. Ann Intern Med 1941; 15:829–39.Google Scholar
Ostrea, E. M., Chavez, C. J., Strauss, M. E. A study of factors that influence the severity of neonatal narcotic withdrawal. J Pediatr 1976; 88:642–5.CrossRefGoogle ScholarPubMed
Green, M., Suffet, F. The neonatal narcotic withdrawal index: A device for the improvement of care in the abstinence syndrome. Am J Drug Alcohol Abuse 1981; 8(2):203–13.Google Scholar
Zahordony, W., Rom, C., Whitney, W., et al. The neonatal withdrawal inventory: A simplified score of newborn withdrawal. Dev Behav Pediatr 1998; 19(2):89–93.CrossRefGoogle Scholar
Kraft, W. K., van den Anker, J. N. Pharmacologic management of the opioid neonatal abstinence syndrome. Pediatr Clin N Am 2012; 59:1147–65.CrossRefGoogle ScholarPubMed
D'Apolito, K., Finnegan, L. Assessing Signs & Symptoms of Neonatal Abstinence Using the Finnegan Scoring Tool, An Inter-Observer Reliability Program, Neo Advances, 2010. www.neoadvances.comGoogle Scholar
Velez, M., Jansson, L. M. The opioid dependent mother and newborn dyad: Non-pharmacological care. J Addict Med 2008; 2(3):133–20.Google Scholar
Wachman, E. M., Newby, P. K., Vreeland, J., et al. The relationship between maternal opioid agonists and psychiatric medications on length of hospitalization for neonatal abstinence. J Addict Med 2011; 5(4):293–9.CrossRefGoogle ScholarPubMed
Welle-Strand, G. K., Skurtveit, S., Jansson, L. M. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr 2014; 165(3):440–6.Google Scholar
Short, V., Gannon, M., Abatemarco, D. J. Association between breastfeeding and length of stay among infants diagnosed with NAS: A population based study of in-hospital births. Breastfeed 2016; 11:343–9.Google Scholar
Vermont Oxford Network (VON) www.public.vtoxford.orgGoogle Scholar
Abrahams, R. R., Key, S. A., Payne, S., et al. Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Can Fam Physicians 2007; 53(10):1722–30.Google Scholar
Newman, A., Davies, G. A., Dow, K., et al. Rooming-in care for infants of opioid dependent mothers: Implementation and evaluation at a tertiary care hospital. Can Fam Physicians 2012; 61(12):555–61.Google Scholar
Saiki, T., Lee, S., Hannam, S. Neonatal abstinence syndrome – Postnatal ward versus neonatal unit management. Eur J Pediatr 2010; 169:95–8.Google Scholar
Hunseler, C., Bruckle, M., Roth, B., Kribs, A. Neonatal opiate withdrawal and rooming-in: A retrospective analysis of a single study experiment. Klin Pediatri 2013; 225(5):247–51.Google Scholar
Holmes, A. V., Atwood, E. C., Whalen, B., et al. Rooming-in to treat neonatal abstinence syndrome: Improved family centered care and lower cost. Pediatrics, 2016; doi: 10.1542/peds.2015-2929.CrossRefGoogle ScholarPubMed
Hall, E. S., Wexelblatt, S. L., Crowley, M., et al. A multicenter cohort study of treatments and hospital outcomes in neonatal abstinence syndrome. Pediatrics, 2014; 14(2):e527–e34.Google Scholar
Asti, L., Magers, J. S., Keels, E., Wispe, J., McClead, R. E. A quality improvement project to reduce length of stay for neonatal abstinence syndrome. Pediatrics, 2015; 135(6):e1494–1500.Google Scholar
Hall, E. S., Wexelblatt, S. L., Crowley, M. Implementation of a neonatal abstinence syndrome scoring weaning protocol. Pediatrics, 2015; 136(4):e803–10.CrossRefGoogle Scholar
Osborn, D. A., Jeffery, H. E., Cole, M. J. Sedatives for opiate withdrawal in newborn infants. Cochrane Database Syst Rev 2010; (10): Art. No. CD002053; doi: 10.1002/14651858.CD002053.pub3.Google Scholar
Jackson, L., Ting, A., McKay, S., Galea, P., Skeoch, C. A randomized controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome. Arch Dis Child 2004; 89(4 Special Issue):F300–4.Google Scholar
Finnegan, L. P., Kaltenbach, K. Neonatal abstinence syndrome. In Hoekelman, R. A., Friedman, S. B., Nelson, N., editors. Primary Pediatric Care. 2nd ed. St. Louis, MO: CV Mosby; 1992, pp. 1367–8.Google Scholar
Kandall, S. R. Treatment strategies for drug-exposed neonates. Clin Perinatol 1999; 26:231–43.CrossRefGoogle ScholarPubMed
Kraft, W. K., Gibson, E., Dysart, K., et al. Sublingual buprenorphine for treatment of neonatal abstinence syndrome: A randomized trial. Pediatrics 2008; 122(3):e601–7.Google Scholar
Kraft, W. K., Dysart, K., Greenspan, J. S. Revised dose schema of sublingual buprenorphine in the treatment of neonatal opioid syndrome. Addiction 2011; 106(3):574–80.CrossRefGoogle Scholar
Kraft, W. K., Adeniyi-Jones, S. C., Chervoneva, I., et al. Buprenorphine for the treatment of the neonatal abstinence syndrome. N Engl J Med 2017; doi: 10.1065/NEJMoa1614835.Google Scholar
Sarkar, S., Dunn, S. M. Management of neonatal abstinence syndrome in neonatal intensive care units: A national survey. J Perinatol 2006;26(1):15–7.Google Scholar
O'Grady, M. J., Hopewell, J., White, M. J. Management of neonatal abstinence syndrome: A national survey and review of practice. Arch Dis Child Fetal Neonatal Ed 2009; 94(4):F249–52.Google Scholar
Weiner, S. M., Finnegan, L. P. Drug withdrawal in the neonate. In Carter, B., Gardner, S., editors. Handbook of Neonatal Intensive Care, 8th ed. St. Louis, MO: Mosby-Year Book Inc; 2016.Google Scholar
Bio, L. L., Siu, A., Poon, C. Y. Update on the pharmacologic management of neonatal abstinence syndrome. J Perinatol 2011; 31(11):692–701.Google Scholar
Osborn, D. A., Jeffery, H. E., Cole, M. Sedatives for opiate withdrawal in newborn infants. Cochrane Database Syst Rev 2002; (3):CD002053.Google Scholar
Osborn, D. A., Jeffery, H. E., Cole, M. Opiate treatment for opiate withdrawal in newborn infants. Cochrane Database Syst Rev 2005; (3):CD002059.Google Scholar
Kocherlakota, P., Neonatal abstinence syndrome, Pediatrics 2014 Aug; 134(2):e547–61.Google Scholar
North Carolina Pregnancy & Opioids Exposure Project. www.ncpoep.org/guidance-document/neonatal-abstinence-syndrome-overview/appendix-a-neonatal-abstinence-syndrome-nas-scoring-explanation/Google Scholar
Ebner, N., Rohrmeister, K., Winklbaur, B., et al. Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Drug Alcohol Depend 2007;87(2–3):131–8.CrossRefGoogle ScholarPubMed
Leikin, J. B., Mackendrick, W. P., Maloney, G. E., et al. Use of clonidine in the prevention and management of neonatal abstinence syndrome. Clin Toxicol (Phila) 2009; 47(6):551–5.Google Scholar
Esmaeili, A., Keinhorst, A. K., Scuster, T., et al. Treatment of neonatal abstinence syndrome with clonidine and chloral hydrate. Acta Paediatr 2010; 99(2):209–14.Google Scholar
Bada, H. S., Sithisarn, T., Gibson, J., et al. Morphine versus clonidine for neonatal abstinence syndrome. Pediatrics 2015 Feb; 135(2):e383–91.Google Scholar
Kaltenbach, K., Finnegan, L. P. Neonatal abstinence: Pharmacotherapy and developmental outcome. Neurobehav Toxicol Teratol 1986; 8:353–5.Google ScholarPubMed
Behnke, M., Smith, V. C. Prenatal substance abuse: Short and long term effects of the exposed fetus. Pediatrics 2013; 131:e1009–e24.Google Scholar

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