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Neonatal abstinence syndrome
Insights
Neonatal Abstinence Syndrome (NAS) in infants is often linked to maternal polydrug abuse. Benzodiazepine exposure can prolong withdrawal symptoms, while morphine sulfate is effective for opiate-related NAS.
Area of Science:
- Neonatalogy
- Pharmacology
- Public Health
Background:
- Neonatal Abstinence Syndrome (NAS) is a significant concern in neonatal intensive care units.
- Maternal drug abuse is a primary cause of NAS, necessitating effective treatment strategies.
Purpose of the Study:
- To investigate the relationship between maternal drug abuse and NAS symptoms in infants.
- To evaluate the effectiveness of pharmacological agents in managing NAS symptoms.
- To determine the length of inpatient stay for infants with NAS.
Main Methods:
- Retrospective review of maternal and infant records over a 12-month period.
- Infants with a serial Finnegan score > 8 received pharmacologic treatment.
- Treatment options included oral morphine sulfate, phenobarbitone, or a combination.
Main Results:
- Polydrug abuse was the most common form of maternal drug use.
- Benzodiazepine exposure was associated with a longer duration of withdrawal symptoms.
- Average treatment duration was 21.8 days, with a total hospital stay of 1,011 days for 43 infants.
Conclusions:
- Morphine sulfate is recommended for treating pure opiate withdrawal symptoms in neonates.
- Understanding maternal drug use patterns is crucial for managing NAS.
- NAS management significantly impacts pediatric bed occupancy.
Abstract:
A 12 month review of infants admitted with neonatal abstinence syndrome to a neonatal intensive care unit was undertaken. The relationship of maternal drug abuse to symptoms, the effectiveness of pharmacologic agents in controlling symptoms and the length of inpatient stay were investigated. A retrospective review of maternal and infant records was performed. Those infants with a serial Finnegan score greater than 8 were treated. Pharmacologic treatment was oral morphine sulphate (0.2 mg 4-6 hourly), phenobarbitone (3-7 mgs/kg/day), or combination of the above. 43 infants were admitted to the hospital during the year. The average maternal age was 24.6 years, (18-34 years). Drug use volunteered by the mothers was methadone alone in 6 cases, methadone and benzodiazepines in 14, methadone and heroin and benzodiazepines in 7, methadone and heroin in 10, heroin alone in 2, and other multiple drug use including oral morphine sulphate, dothiepin and cannabis in 4. Average gestational age was 40.3 (35-42 weeks). The average birthweight was 2.81 kgs (1.89-3.91 kgs). Time to onset of withdrawal symptoms was 2.8 (1-13) days. The duration of pharmacologic treatment (oral morphine sulphate and/or phenobarbitone) was 21.8 (1-62) days. The total hospital stay for the 43 infants was 1,011 days. This study confirms that polydrug abuse is the commonest type of drug abuse in Dublin. The duration of withdrawal symptoms is loosely related to drug type, but increasing duration of symptoms is noted for infants exposed to benzodiazepines. Our experience would favour the use of morphine sulphate to treat pure opiate withdrawal symptoms. Over the 12-month period, there was an average occupancy of 3 beds per day in the paediatric department.