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Klin Padiatr 2013; 225(05): 252-256
DOI: 10.1055/s-0033-1349096
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Treatment of Neonatal Abstinence Syndrome in Preterm and Term Infants

Behandlung des neonatalen Entzugssyndroms von Früh- und Neugeborenen
M. T. Dabek
1   Division of Neonatology, Department of Pediatrics, University of Heidelberg, Germany
,
J. Poeschl
1   Division of Neonatology, Department of Pediatrics, University of Heidelberg, Germany
,
S. Englert
2   Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
,
P. Ruef
1   Division of Neonatology, Department of Pediatrics, University of Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 July 2013 (online)

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Abstract

Objective:

Neonatal abstinence syndrome (NAS) is treated with a variety of drug preparations. With the optional treatment of NAS with chloral hydrate, phenobarbital or morphine the cumulative drug consumption of the mentioned drugs, the length of hospital stay and treatment duration was evaluated in preterm and term neonates.

Methods:

Retrospective, uncontrolled study which evaluates different therapies of neonatal abstinence syndrome (NAS) in preterm and term neonates.

Results:

During the past 16 years data were obtained from medical records of 51 neonates with NAS; 9 preterm and 35 term neonates were evaluated and 7 were excluded because of incomplete data sets. 31 (72.1%) received a pharmacological treatment (6 preterm and 25 term neonates). Treatment started at 4.3 [3.3–5.3] d. Mean duration of treatment was 11.7 [6.6–16.7] d. In our study chloral hydrate (ch) and phenobarbital (pb) were first line medication escalated by the morphine (mp) solution. Mean cumulative dosage of ch was 643.5 [260.3–1 026.7] mg, of pb 53.2 [19.7–86.8] mg and of mp 4.22 [0–8.99] mg.

Conclusion:

Our study group showed similar treatment duration and length of hospital stay compared to other studies. The cumulative dose of mp was lower compared to most studies. This benefit resulted at the expense of a further medication with pb and ch. However, 6 of 9 preterm neonates needed significantly less pharmacological therapy compared to term neonates indicating less susceptibility of immature brain to abstinence of maternalo­pioids.

Zusammenfassung

Hintergrund:

Das neonatale Entzugssyndrom (NAS) wird mit unterschiedlichen Medikamenten-gruppen behandelt. In unserer Klinik erfolgte die Behandlung mit Chloralhydrat (ch), Phenobarbital (pb) und/oder Morphin (mp). Es wurde die kumulative Medikamentendosis, die Länge des Kran­kenhausaufenthaltes und die Behandlungsdauer bei Frühgeborenen (FG) und Neugeborenen (NG) ausgewertet.

Methodik:

In einer retrospektiven, unkontrollierten Studie wurde die Notwendigkeit und Wirkung von unterschiedlichen Medikamenten auf Früh- und Neugeborene mit NAS untersucht.

Ergebnisse:

Während der letzten 16 Jahre wurden 51 Neugeborene behandelt, von denen 7 wegen unvollständiger Daten ausgeschlossen wurden. Von den 44 Patienten waren 9 Frühgeborene. 31 (72,1%) benötigten eine medikamentöse Therapie (6 FG; 25 NG). Der Therapiebeginn lag bei 4,3 [3,3–5,3] Tagen, und die mittlere Dauer betrug 11,7 [6,6–16,7] Tage. Die mittlere Dosis betrug von ch 643,5 [260,3–1 026,7] mg, von pb 53,2 [19,7–86,8] mg und von mp 4,22 [0–8,99] mg.

Schlussfolgerungen:

Die Behandlungsdauer und die Krankenhaustage waren mit anderen Studien vergleichbar. Allerdings war die kumulative mp-Dosis geringer, was auf die zusätzliche Gabe von ch und pb zurückzuführen ist. Die 6 FG brauchten weniger Medikamente und eine kürzere Therapie. Dies mag ein Hinweis sein, dass das unreife Gehirn auf den Entzug mütterlicher Opioide weniger empfindlich reagiert.

Key words

neonatal abstinence ­syndrome - preterms - term infant - drug therapy

Schlüsselwörter

neonatales Entzugsyndrom - Frühgeborene - Neugeborene - Therapie
 

  • References

  • 1 American Academy of Pediatrics Section on Breastfeeding . Breastfeeding and the use of human milk. Pediatrics 2012; 129: e827-e841
    CrossrefPubMedGoogle Scholar
  • 2 Bio LL, Siu A, Poon CY. Update on the pharmacologic management of neonatal abstinence syndrome. J Perinatol 2011; 31: 692-701
    CrossrefPubMedGoogle Scholar
  • 3 Bittigau P, Sifringer M, Ikonomidou C. Antiepileptic drugs and apoptosis in the developing brain. Ann N Y Acad Sci 2003; 1993: 103-114
    PubMedGoogle Scholar
  • 4 Bläser A, Pulzer F, Knüpfer M et al. Drug withdrawal in newborns – clinical data of 49 infants with intrauterine drug exposure: What should be done?. Klin Padiatr 2008; 2205: 308-315
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Buchi KF, Suarez C, Varner MW et al. The prevalence of prenatal opioid and other drug use in utah. Am J Perinatol 2013; 30: 241-244
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Dalen K, Bruarøy S, Wentzel-Larsen T et al. Cognitive functioning in children prenatally exposed to alcohol and psychotropic drugs. Neuropediatrics 2009; 40: 162-167
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Dysart K, Hsieh H, Kaltenbach K et al. Sequela of preterm versus term infants born to mothers on a methadone maintenance program: differential course of neonatal abstinence syndrome. J Perinat Med 2007; 35: 344-346
    CrossrefPubMedGoogle Scholar
  • 8 Esmaeili A, Keinhorst AK, Schuster T et al. Treatment of neonatal abstinence syndrome with clonidine and chloral hydrate. Acta Paediatr 2010; 99: 209-214
    PubMedGoogle Scholar
  • 9 Fachverband Drogen- und Suchthilfe e.V. Positionspapier: Drogen, Schwangerschaft, Kind 2009
    PubMed
  • 10 Hudak ML, Tan RC. Committee on drugs; Committee on fetus and newborn; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012; 129: e540-e560
    CrossrefPubMedGoogle Scholar
  • 11 Hulse GK, Milne E, English DR et al. The relationship between maternal use of heroin and methadone and infant birth weight. Addiction 1997; 92: 1571-1579
    CrossrefPubMedGoogle Scholar
  • 12 Hüning BM, Reimann M, Beerenberg U et al. Establishment of a family-centred care programme with follow-up home visits: implications for clinical care and economic characteristics. Klin Padiatr 2012; 224: 431-436
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Jansson LM, Choo R, Velez ML et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 2008; 121: 106-114
    CrossrefPubMedGoogle Scholar
  • 14 Johnson K, Gerada C, Greenough A. Treatment of neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed 2003; 88: F2-F5
    CrossrefPubMedGoogle Scholar
  • 15 Jones HE, O’Grady KE, Malfi D et al. Methadone maintenance vs. methadone taper during pregnancy: maternal and neonatal outcomes. Am J Addict 2008; 17: 372-386
    CrossrefPubMedGoogle Scholar
  • 16 Jones HE, Kaltenbach K, Heil SH et al Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med 2010; 363: 2320-2331
    CrossrefPubMedGoogle Scholar
  • 17 Kaltenbach K, Berghella V, Finnegan L. Opioid dependence during pregnancy: effects and management. Obstet Gynecol Clin North Am 1998; 25: 139-151
    CrossrefPubMedGoogle Scholar
  • 18 Kaltenbach K, Finnegan LP. Neonatal abstinence syndrome. pharmacotherapy and developmental outcome. Neurobehav Toxicol Teratol 1986; 8: 353-355
    PubMedGoogle Scholar
  • 19 Mattick RP, Kimber J, Breen C et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2008; 2 CD002207
    PubMedGoogle Scholar
  • 20 Messinger DS, Bauer CR, Das A et al. The Maternal Lifestyle Study: cognitive, motor, and behavioral outcomes of cocaine-exposed and opiate-exposed infants through three years of age. Pediatrics 2004; 113: 1677-1685
    CrossrefPubMedGoogle Scholar
  • 21 Müller MJ, Lange M, Paul T et al. Breast feeding during methadon- and buprenorphin therapy. Klin Padiatr 2011; 223: 408-413
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 O’Grady MJ, Hopewell J, White MJ. Management of neonatal abstinence syndrome: a national survey and review of practice. Arch Dis Child Fetal Neonatal Ed 2009; 94: F249-F252
    CrossrefPubMedGoogle Scholar
  • 23 Osborn DA, Jeffery HE, Cole MJ. Opiate treatment for opiate withdrawal in newborn infants. Cochrane Database Syst Rev 2005; CD002059
    PubMedGoogle Scholar
  • 24 Reinisch JM, Sanders SA, Mortensen EL et al. In Utero Exposure to Phenobarbital and Intelligence Deficits in Adult Men. JAMA 1995; 274: 1518-1525
    CrossrefPubMedGoogle Scholar
  • 25 Rho JM, Donevan SD, Rogawski MA. Direct activation of GABAA receptors by barbiturates in cultured rat hippocampal neurons. J Physiol 1996; 497 (Pt 2) 509-522
    PubMedGoogle Scholar
  • 26 Rockville MD. Results from the 2009 National Survey on Drug use and Health: Volume I. Summary of National findings. U.S. Department of Health and Human Services SAMHA 2010; 31-45
    PubMedGoogle Scholar
  • 27 Sarkar S, Donn SM. Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey. J Perinatol 2006; 26: 15-17
    CrossrefPubMedGoogle Scholar
  • 28 Welle-Strand GK, Skurtveit S, Jones HE et al. Neonatal outcomes following in utero exposure to methadone or buprenorphine: A National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009. Drug Alcohol Depend 2013; 127: 200-206
    CrossrefPubMedGoogle Scholar
  • 29 Winklbaur B, Kopf N, Ebner N et al Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a knowledge synthesis for better treatment for women and neonates. Addiction 2008; 103: 1429-1440
    CrossrefPubMedGoogle Scholar