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Reversal of Opioid Intoxication in an Infant With Intrauterine Growth Restriction With a Single Dose of Naloxone

Utsav Timalsina1, Ann Andrasovich1, Fernanda E Kupferman1

  • 1Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, USA.

Cureus
|November 22, 2021
PubMed

Insights

Naloxone may be cautiously used in newborns with opioid exposure and respiratory distress, especially those with intrauterine growth restriction (IUGR). This case highlights its potential benefit when administered carefully to opioid-intoxicated infants.

Area of Science:

  • Neonatal Medicine
  • Pharmacology
  • Developmental Pediatrics

Background:

  • Perinatal opioid exposure can lead to neonatal opioid intoxication.
  • Routine naloxone use in newborns is generally discouraged due to risks of withdrawal and developmental issues.
  • Intrauterine growth restriction (IUGR) presents unique challenges in neonatal care.

Observation:

  • A neonate with IUGR exposed to opioids in utero presented with respiratory and neurological depression at birth.
  • Initial positive pressure ventilation improved the infant's tone and respiratory effort.
  • Delayed bradypnea, shallow breathing, and oxygen desaturation occurred eight hours after birth.

Findings:

  • A single dose of intravenous naloxone successfully reversed the respiratory and neurological depression.
  • The infant, exposed to hydromorphone, showed significant improvement post-naloxone administration.
  • The infant was discharged on day seven with no residual symptoms.

Implications:

  • Naloxone administration may be considered for IUGR infants with persistent cardiorespiratory and neurological depression following recent intrauterine opioid exposure.
  • Careful consideration is needed, particularly if the mother is not narcotic dependent.
  • This case suggests a potential role for naloxone in specific neonatal opioid intoxication scenarios.

Keywords:
hydromorphoneintrauterine growth restrictionnaloxoneneonatal depressionopioid exposure during labor

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