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Effects of Partially Hydrolyzed Formula on Severity and Outcomes of Neonatal Abstinence Syndrome
Objective This study compares the effect of partially hydrolyzed formula (PHF) and standard formula (SF) on the severity and short-term outcomes of neonatal abstinence syndrome (NAS).
Study Design We performed a retrospective chart review of 124 opioid-dependent mothers and their term or near-term infants. Infants were categorized according to the predominant type of formula consumed during the hospital stay. Finnegan's scale was used to assess symptoms of withdrawal.
Results A total of 110 infants met our inclusion criteria. Thirty-four (31%) infants were fed predominantly PHF, 60 (54%) infants were fed SF, and 16 (15%) infants were fed maternal breast milk. There was no difference between the infants in the PHF and SF groups with respect to requirement of morphine (MSO4) therapy, maximum dose of MSO4 used, duration of MSO4 treatment or length of hospital stay after performing multivariate analyses to control for type of drug used by the mother, maternal smoking, regular prenatal care, inborn status, and maximum Finnegan score prior to MSO4 treatment.
Conclusion Use of PHF failed to impact short-term outcomes in infants treated for NAS including maximum MSO4 dose, duration of MSO4 treatment, and length of hospital stay. A prospective randomized controlled trial may be indicated to confirm this finding.
Statistical analysis reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number UL1TR001412.
Received: 14 April 2019
Accepted: 09 May 2019
25 June 2019 (online)
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- 1 Kocherlakota P. Neonatal abstinence syndrome. Pediatrics 2014; 134 (02) e547-e561
- 2 Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012; 307 (18) 1934-1940
- 3 Wright TE. Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge, UK: Cambridge University Press; 2018
- 4 Finnegan LP, Connaughton Jr JF, Kron RE, Emich JP. Neonatal abstinence syndrome: assessment and management. Addict Dis 1975; 2 (1-2): 141-158
- 5 McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med 2016; 375 (25) 2468-2479
- 6 Stover MW, Davis JM. Opioids in pregnancy and neonatal abstinence syndrome. Paper presented at Seminars in Perinatology; 2015
- 7 Hudak ML, Tan RC. Neonatal drug withdrawal. Pediatrics 2012; 129 (02) e540-e560
- 8 Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol 2015; 35 (08) 650-655
- 9 Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstet Gynecol 2011; 204 (03) 259.e1-259.e4
- 10 Haas A. Identification of neonatal abstinence syndrome in the community: infants born into Canada's opioid crisis. Paediatr Child Health 2019; 24 (02) 81-84
- 11 Maguire D, Gröer M. Neonatal abstinence syndrome and the gastrointestinal tract. Med Hypotheses 2016; 97: 11-15
- 12 Abdel-Latif ME, Pinner J, Clews S, Cooke F, Lui K, Oei J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006; 117 (06) e1163-e1169
- 13 Malpas T, Darlow B, Horwood J. Breastfeeding reduces the severity of neonatal abstinence syndrome. J Paediatr Child Health 1997; 33 (04) A38
- 14 O'Connor AB, Collett A, Alto WA, O'Brien LM. Breastfeeding rates and the relationship between breastfeeding and neonatal abstinence syndrome in women maintained on buprenorphine during pregnancy. J Midwifery Womens Health 2013; 58 (04) 383-388
- 15 Liu A, Juarez J, Nair A, Nanan R. Feeding modalities and the onset of the neonatal abstinence syndrome. Front Pediatr 2015; 3: 14
- 16 Walsh MC, Crowley M, Wexelblatt S. , et al; Ohio Perinatal Quality Collaborative. Ohio perinatal quality collaborative improves care of neonatal narcotic abstinence syndrome. Pediatrics 2018; 141 (04) e20170900
- 17 Bogen DL, Whalen BL, Kair LR, Vining M, King BA. Wide variation found in care of opioid-exposed newborns. Acad Pediatr 2017; 17 (04) 374-380
- 18 Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am 2013; 60 (01) 49-74
- 19 Belamarich PF, Bochner RE, Racine AD. A critical review of the marketing claims of infant formula products in the United States. Clin Pediatr (Phila) 2016; 55 (05) 437-442
- 20 Liu AJ, Jones MP, Murray H, Cook CM, Nanan R. Perinatal risk factors for the neonatal abstinence syndrome in infants born to women on methadone maintenance therapy. Aust N Z J Obstet Gynaecol 2010; 50 (03) 253-258
- 21 Doberczak TM, Kandall SR, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr 1991; 118 (06) 933-937
- 22 Maguire D, Cline GJ, Parnell L, Tai C-Y. Validation of the Finnegan neonatal abstinence syndrome tool-short form. Adv Neonatal Care 2013; 13 (06) 430-437
- 23 Francavilla R, Calasso M, Calace L. , et al. Effect of lactose on gut microbiota and metabolome of infants with cow's milk allergy. Pediatr Allergy Immunol 2012; 23 (05) 420-427
- 24 Cederlund A, Kai-Larsen Y, Printz G. , et al. Lactose in human breast milk an inducer of innate immunity with implications for a role in intestinal homeostasis. PLoS One 2013; 8 (01) e53876
- 25 Abrams SA, Griffin IJ, Davila PM. Calcium and zinc absorption from lactose-containing and lactose-free infant formulas. Am J Clin Nutr 2002; 76 (02) 442-446
- 26 Lee Y-H. Food-processing approaches to altering allergenic potential of milk-based formula. J Pediatr 1992; 121 (5 Pt 2): S47-S50
- 27 Kinouchi T, Koyama S, Harada E, Yajima T. Large molecule protein feeding during the suckling period is required for the development of pancreatic digestive functions in rats. Am J Physiol Regul Integr Comp Physiol 2012; 303 (12) R1268-R1276
- 28 Vandenplas Y, Alarcon P, Fleischer D. , et al. Should partial hydrolysates be used as starter infant formula? A working group consensus. J Pediatr Gastroenterol Nutr 2016; 62 (01) 22-35
- 29 Holzer P. Pharmacology of opioids and their effects on gastrointestinal function. Am J Gastroenterol Suppl 2014; 2 (01) 9
- 30 Miraglia Del Giudice M, D'Auria E, Peroni D. , et al. Flavor, relative palatability and components of cow's milk hydrolysed formulas and amino acid-based formula. Ital J Pediatr 2015; 41 (01) 42
- 31 Armentrout DC, Caple J. The jittery newborn. J Pediatr Health Care 2001; 15 (03) 147-149
- 32 Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics 2002; 109 (04) 590-593
- 33 Begg EJ, Malpas TJ, Hackett LP, Ilett KF. Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing. Br J Clin Pharmacol 2001; 52 (06) 681-685
- 34 Kauffman RE, Banner W, Berlin C. , et al. American Academy of Pediatrics Committee on Drugs: the transfer of drugs and other chemicals into human milk. Pediatrics 1994; 93 (01) 137-150
- 35 Lindemalm S, Nydert P, Svensson J-O, Stahle L, Sarman I. Transfer of buprenorphine into breast milk and calculation of infant drug dose. J Hum Lact 2009; 25 (02) 199-205
- 36 Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med 2012; 7 (04) 269-274