Newborn and Infant Nursing Reviews
Volume 9, Issue 1 , Pages 62-69 , March 2009

Neonatal Opiate Withdrawal: Pharmacologic Management

  • Karen D'Apolito, PhD, APRN, CNS, NNP

      Affiliations

    • Corresponding Author InformationAddress correspondence to Karen D'Apolito, PhD, APRN, CNS, NNP, Program Director, Neonatal Nurse Practitioner Program, Vanderbilt University School of Nursing, 461 21st Ave. South, Nashville, TN 37240.

References 

  1. Substance Abuse & Mental Health Services Administration, Office of Applied Studies . Results for the 2007 National Survey on Drug Use and Health. National Findings (NSDUH Series H-34, DHHS Publication No. SMA 08-4343). 2008;Available at: www.oas.SAMHSA.gov/NSDH/2k7NSDUH/2k7results.cfm#2.6[Retrieved January 8, 2009]
  2. National Survey on Drug Use & Health . Department of Health & Human Services: SAMHSA. 2007;http://www.oas.samhsa.gov/nsduhLatest.htm
  3. American Academy of Pediatrics Committee on Drugs: Neonatal drug withdrawal. Pediatrics. 1998;101:1079–1088
  4. Merker L, Higgens L, Kinnare E. Assessing narcotic addiction in neonates. Pediatr Nurs. 1985;11:177–181
  5. Hamdan A. Neonatal abstinence syndrome. Emedicine. 2008;1–15www.emedicine.com/ped/TOPIC2760.HTM
  6. Kaltenbach K, Finnegan L. Neonatal abstinence: pharmacotherapy and developmental outcome. Neurobehav Toxicol Teratol. 1986;8:353–355
  7. Finnegan L, Connaughton J, Kron R, et al. Neonatal abstinence syndrome: assessment and management. Addict Dis. 1975;2:141–158
  8. Ostrea E, Chavez C, Strauss M. A study of factors that influence the severity of neonatal narcotic withdrawal. Addict Dis. 1975;2:187–199
  9. Wachsman L, Schuetz C, Wingert W. What happens to babies exposed to phencyclidine (PCP) in utero?. Am J Drug Alcohol Abuse. 1989;5:31–39
  10. Alroomi L, Davidson J, Evan T, et al. Maternal narcotic abuse and the newborn. Arch Dis Child. 1988;63:81–83
  11. Gorski P, Davidson M, Brazelton TB. Stages of behavioral organization in the high-risk neonate: theoretical and clinical considerations. Semin Perinatol. 1979;3:61–72
  12. Suresh S, Anand S. Opiate tolerance in neonates: mechanisms, diagnosis, assessment and management. Semin Perinatol. 1998;22:425–433
  13. Finnegan L, McNew B. Care of the addicted infant. Am J Nurs. 1974;74:685–693
  14. Rosette H, Ouellette E, Weiner L, et al. Therapy of heavy drinking during pregnancy. Obstet Gynecol. 1988;51:41–46
  15. Powell J. The tragedy of fetal alcohol syndrome. RN. 1981;33:94–96
  16. Scher M, Richardson G, Goble P, et al. The effects of prenatal alcohol and marijuana exposure: disturbances in neonatal sleep, cycling and arousal. Pediatr Res. 1988;24:101–105
  17. Oro A, Dixon S. Perinatal cocaine and methamphetamine exposure: maternal and neonatal correlates. J Pediatr. 1987;111:571–578
  18. Desmond M, Schwanecke R, Wilson G, et al. Maternal barbiturate utilization and neonatal withdrawal symptomatology. J Pediatr. 1972;80:190–197
  19. Kaltenbach K, Berghella V, Finnegan L. Opioid dependence during pregnancy: effects and management. Obstet Gynecol Clin North Am. 1998;25:139–151
  20. Kandall S, Doberczak T, Jantuenem M, et al. The methadone-maintained pregnancy. Clin Perinatol. 1999;26:173–183(review)
  21. Dashe J, Sheffield J, Olscher D, et al. Relationship between maternal methadone dosage and neonatal withdrawal. Obstet Gynecol. 2002;100:1244–1249
  22. Harper R, Sloish G, Feingold E, et al. Maternal ingested methadone, body fluid methadone, and the neonatal withdrawal syndrome. Am J Obstet Gynecol. 1977;129:417–424
  23. Tatiana M, Doberczak M, Stephen R, et al. Relationships between maternal methadone dosage, maternal-neonatal methadone levels, and neonatal withdrawal. Obstet Gynecol. 1993;81:936–940
  24. Rosen T, Pippenger C. Pharmacologic observations on the neonatal withdrawal syndrome. J Pediatr. 1976;88:1044–1048
  25. Mack G, Thomas D, Giles W, et al. Methadone concentrations and neonatal withdrawal. J Pediatr Child Health. 1991;27:96–100
  26. Kuschel C, Austerberry L, Cornwell M, et al. Can methadone concentrations predict the severity of withdrawal in infants at risk of neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed. 2004;89:F390–F393
  27. Berghetta V, Lim P, Hill M, et al. Maternal methadone dose and neonatal withdrawal. Am J Obstet Gynecol. 2003;189:312–317
  28. Stewart C, Hampton E. Effects of maturation on drug disposition in pediatric patients. Clin Pharm. 1987;6:548–564
  29. Reed M, Besunder J. Developmental pharmacology: ontogenic basis of drug disposition. Pediatr Clin North Am. 1989;36:1053–1074
  30. Lipsitz J. A proposed narcotic withdrawal score for use with newborn infants. Clin Pediatr. 1975;14:592–594
  31. 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;8:203–213
  32. Zahorodny W, Rom C, Whitney W, et al. The Neonatal Withdrawal Inventory: a simplified score of newborn withdrawal. Dev Behav Pediatr. 1998;19:89–93
  33. Finnegan L, Connaughton J, Kron R, et al. Neonatal abstinence syndrome: assessment and management. Addictive disease. Int J. 1975;2:141–158
  34. Lainwala S, Brown E, Weinschenk N, et al. 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;5:265–272
  35. Zenk K, Sills J, Koeppel R. Neonatal medications & nutrition: a comprehensive guide. California: NICU Inc.; 2003;
  36. Finnegan L, Mitros T, Hopkins L. Management of neonatal narcotic abstinence utilizing a phenobarbital loading dose method. NIDA Res Monogr. 1979;27:262–268
  37. Zuckerman B, Frand D, Brown E. Overview of the effects of abuse and drugs on pregnancy and offspring. NIDA Res Monogr. 1995;149:16–28
  38. Nelsen H, Wiriyathian S, Rosenfeld R, et al. Chlorpromazine excretion by the neonate following chronic in utero exposure. Pediatr Pharmacol. 1983;3:1–5
  39. Osborn K, Jeffery H, Cole M. Sedatives for opiate withdrawal in newborn infants. Cochrane Library. 2002;3:1–25
  40. Kandall S, Doberczak T, Mauer K, et al. Opiate vs CNS depressant therapy in neonatal drug abstinence syndrome. Am J Dis Child. 1983;137:378–382
  41. Carin I, Glass L, Parekh A, et al. Neonatal methadone withdrawal. Effects of two treatment regimens. Am J Dis Child. 1983;137:1166–1169
  42. Coyle M, Ferguson A, LaGasse L, et al. Diluted tincture of opium (DTO) and phenobarbital versus DTO alone for neonatal opiate withdrawal in term infants. J Pediatr. 2002;140:561–564
  43. Coyle M, Ferguson A, LaGasse L, et al. Neurobehavioral effects of treatment for opiate withdrawal. Arch Dis Child Fetal Neonatal Ed. 2005;90:F73–F74
  44. Jackson L, Ting A, Mckay S, et al. A randomized controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed. 2004;89:F300–F304
  45. Lester B, Tronick E. Behavioral assessment: the NICU Network Neurobehavioral Scale. Pediatrics. 2004;113:641–667
  46. Ballard J. Treatment of neonatal abstinence syndrome with breast milk containing methadone. J Perinat Neonatal Nurs. 2002;14:76–85
  47. Kraft W, Gibson E, Dysart K, et al. Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial. Pediatrics. 2008;122:e601–e607
  48. American Academy of Pediatrics Committee on Drugs . Neonatal drug withdrawal. Pediatrics. 1983;72:895–902
  49. Child Health Network Guidelines . In: Management of perinatal substance use and abuse. 2002;p. 1–9Toronto, Canada
  50. Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Professional. St. Louis: Saunders; 2005;
  51. Blinick G, Inturriel C, Jerez B, et al. Methadone assays in pregnant women and progeny. Am J Obstet Gynecol. 1975;121:612–621
  52. American Academy of Pediatrics Committee on Drugs . The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776–789
  53. Malpas T, Wallach R, Hackett L, et al. Breastfeeding reduces the severity of neonatal abstinence syndrome. J Pediatr Child Health. 1997;33:A38
  54. Malpas T, Horwood J, Darlow B. Neonatal abstinence syndrome following abrupt cessation of breastfeeding. N Z Med J. 1999;112:12–13

☆ This study was supported in part by a grant received by the National Institute on Drug Addiction.

PII: S1527-3369(08)00171-2

doi: 10.1053/j.nainr.2008.12.009

Newborn and Infant Nursing Reviews
Volume 9, Issue 1 , Pages 62-69 , March 2009

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