Pharmacologic Therapy for Neonatal Abstinence Syndrome
A pregnant woman who happens on a continuous exposure to various therapeutic agents during her gestation period may give birth to a neonate suffering from Neonatal Syndrome. The most common cause of NAS are opioids such as heroin, codeine and morphine and is commonly termed as opioid withdrawal syndrome but also other legally or illegally sold substances over the counter can contribute to this syndrome. Infants also develop some kind of addition in the womb when exposed to some antidepressants such as barbiturates and benzodiazepine. There are two kinds of NAS that exist, prenatal NAS which is as a result of the termination of medication being used with a pregnant mother and postnatal NAS which occurs as a result of the termination of drugs directly to the infant. The most frequently occurring syndrome consists of tremor, insomnia, perspiration, Common syndrome according to the frequency includes tremor, high-pitched sneezing sound, increased muscle tone, regurgitation and emesis, loose stools, s, excoriation, mottling, nasal congestion low-grade fever, and tachypnea. Opioid withdrawal symptoms can be a reflection of other symptoms of other conditions in a new-born, such as infections, hypoglycaemia, hypocalcaemia, hypothyroidism, and brain complications (eg., cerebral palsy). The need and time frame of treatment is reduced by breastfeeding. All NAS babies need to be followed up regularly. Not all infants will require treatment with pharmacotherapy, but all should receive non-pharmacologic interventions.
Keywords: Neonatal abstinence syndrome; Nonpharmacological management; Methadone; Morphine; Opioids; Pharmacological management; Phenobarbital; Protocol.
2. Behnke M., Smith V. Committee on substance abuse. Prenatal substance abuse, short and long term effects on the exposed fetus. Pediatrics, 2013; 131(3):1009- 1024. Doi, 10.1542/peds.2012 -3931.
3. Capasso, A., Gallo C. Molecules acting on CB1 receptor and their effects on morphine withdrawal in vitro. Open Biochem J., 2009; 3:78–84.
4. Coyle M.G., Ferguson A., Lagasse, L., Oh, W., Lester, B. A diluted tincture of opium and phenobarbital versus DTO alone for neonatal opiate withdrawal in term infants. J Pediatr.[Pub Med]. 2002; 140:561–4.
5. Finnegan L., Kaltenbach, K. Neonatal abstinence syndrome In, Hoekman, R., Friedman, S., Nelson N, et al, eds.Primary Pediatric Care. St. Louis, MO, Mosby: year Book, 1992-1367-1378.
6. Gowing L., Ali, R., White, J.M. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev, (3)-CD002025.
7. Jansson L.M., Velez M., Harrow C. The opioid-exposed newborn, assessment and pharmacologic management. J Opioid Manag. 2009; 5 (1):47-55.
8. Kocherlakota P. Neonatal abstinence syndrome.Pediatrics . 2014; 134 (2):e547-61.
9. Kraft W.K., Stover M.W., Davis J.M. Neo-Natal abstinence syndrome. pharmacologic strategies for the mother and infant. Semin Perinatol 2016; 40:203-12.
10. Kuschel C. Managing drug withdrawal in the newborn infant. Semin Fetal Neonatal Med . 2007; 12(2):127-33.
11. Kuschel C. Managing drug withdrawal in the newborn infant. Semin Fetal Neonatal Med. 2007; 12(2):127-133.
12. Lainwala, S., Brown, E.R., Weinschenk, N.P., Blackwell, M.T., Hagadorn, J.I. A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care. 2005; 5:265–72.
13. Nancy J., MacMullen, Evidence-based interventions for neonatal abstinence syndrome 2014; 40(4).
14. Nanovskaya, T.N., Nekhayeva, Hankins, G.D.V., Ahmed, M.S. Transfer of methadone across the dually perfused preterm human placental lobule. A.m. J. Obstet, Gynecol. 2008; 198:126.e1–e4.
15. Oei J., Lui K. Management of the newborn infant affected by maternal opiates and other drugs of dependency. J Paediatr child health 2007; 43(1-2):9-18.
16. Ornoy A., Dakota L., Goldzweig G., et al. Neurodevelopmental and psychological assessment of adolescents born to drug-addicted parents, effects of SES and adoption. Child Abuse Neglect. 2010; 34:354–68.
17. Pitlick W., Painter M., Pippenger C. Phenobarbital pharmacokinetics in neonates. Clin Pharm Ther.[Pub Med] 1978; 23:346–50.
18. Sanj E.J., De-las-Cuevas C., Kiuru A., Bate, A., Edwards, R. Selective serotonin inhibitors in pregnant women and neonatal withdrawal syndrome. a database analysis. Lancet. 2005; 365(9458):482–487.
19. Shearer J.N., Journal of Neonatal Nursing (2018), https://doi.org/10.1016/j.jnn.2018.06.002].
20. Velez, M., & Jansson, M. The opioid-dependent mother and newborn dyad, Nonpharmacologic care. Journal of Addiction Medicine, 2008; 2(3):113-120.
21. Wachman E.M., Byrun J., Philip, B.L. Breastfeeding rates among mothers of infants with neonatal abstinence syndrome. Paper presented at Pediatric Academic Society Meeting; May 1–4, Boston, MA. 2012.
22. Welle-Strand G.K., Skurtveit S., Jansson L.M., Bakstad B., Bjarkø L., Ravndal E. Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatr. 2013; 102(11):1060–1066
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