RESUMO
BACKGROUND: Pregnant women treated with methadone as opioid maintenance therapy are more likely than women treated with buprenorphine to deliver preterm. Preterm birth is associated with less risk of neonatal abstinence syndrome (NAS). We sought to assess the role of preterm birth as a mediator of the relationship between in utero exposure to methadone and NAS compared with buprenorphine. METHODS: We studied 716 women receiving methadone or buprenorphine and delivering liveborn infants at Magee-Womens Hospital, Pittsburgh, Pennsylvania (2013-15). We implemented inverse probability weighted marginal structural models to isolate the role of preterm birth (<37 weeks' gestation). Weights accounted for confounding by maternal age, race, insurance, parity, delivery year, marital, employment, hepatitis C, and smoking status. RESULTS: Approximately 57% of the cohort were treated with methadone. Preterm birth was more common in methadone-exposed pregnancies (25% versus 14%). The incidence of NAS treatment was higher in methadone compared with buprenorphine-exposed infants (65% vs 49%), and term compared with preterm births (64% vs 36%). For every 100 infants liveborn to mothers treated for opioid dependence, there were 13 excess cases of NAS among infants exposed to methadone compared with buprenorphine (adjusted risk difference [RD] 13.3, 95% confidence interval [CI] 5.7, 20.9). Among term births, this increased to 17 excess cases of NAS in methadone- compared with buprenorphine-exposed (RD 16.7, 95% CI 9.3, 24.0). CONCLUSION: The further increased risk of NAS associated with methadone use vs buprenorphine in term deliveries emphasises the utility of buprenorphine in clinical settings aimed at decreasing NAS.
Assuntos
Síndrome de Abstinência Neonatal/epidemiologia , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Adulto , Buprenorfina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Idade Materna , Metadona/uso terapêutico , Síndrome de Abstinência Neonatal/etiologia , Tratamento de Substituição de Opiáceos/mortalidade , Pennsylvania/epidemiologia , Gravidez , Nascimento Prematuro , Fatores de RiscoRESUMO
El síndrome de abstinencia neonatal (SAN) debido a la exposición prenatal al citalopram se desarrolla durante los primeros días de vida, incluso con una exposición al fármaco en dosis bajas. El tratamiento de apoyo es la primera opción, aunque puede usarse el fenobarbital en el tratamiento de este síndrome. No debe interrumpirse la lactancia. Debe hacerse un seguimiento de estos recién nacidos para establecer el desenlace del SAN y las consecuencias en el desarrollo neurológico. En este artículo presentamos el caso de un recién nacido con SAN debido a exposición al citalopram en una dosis más baja que lo informado previamente en la bibliografía durante los últimos seis meses del embarazo. Se utilizó el fenobarbital debido al fracaso del tratamiento no farmacológico.
Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.
Assuntos
Humanos , Masculino , Gravidez , Recém-Nascido , Síndrome de Abstinência Neonatal/etiologia , Citalopram/efeitos adversos , Antidepressivos de Segunda Geração/efeitos adversos , Fenobarbital/uso terapêutico , Complicações na Gravidez/psicologia , Complicações na Gravidez/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal , Síndrome de Abstinência Neonatal/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Anticonvulsivantes/uso terapêuticoRESUMO
Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.
El síndrome de abstinencia neonatal (SAN) debido a la exposición prenatal al citalopram se desarrolla durante los primeros días de vida, incluso con una exposición al fármaco en dosis bajas. El tratamiento de apoyo es la primera opción, aunque puede usarse el fenobarbital en el tratamiento de este síndrome. No debe interrumpirse la lactancia. Debe hacerse un seguimiento de estos recién nacidos para establecer el desenlace del SAN y las consecuencias en el desarrollo neurológico. En este artículo presentamos el caso de un recién nacido con SAN debido a exposición al citalopram en una dosis más baja que lo informado previamente en la bibliografía durante los últimos seis meses del embarazo. Se utilizó el fenobarbital debido al fracaso del tratamiento no farmacológico.
Assuntos
Antidepressivos de Segunda Geração/efeitos adversos , Citalopram/efeitos adversos , Síndrome de Abstinência Neonatal/etiologia , Anticonvulsivantes/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Masculino , Síndrome de Abstinência Neonatal/tratamento farmacológico , Fenobarbital/uso terapêutico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/psicologia , Efeitos Tardios da Exposição Pré-NatalRESUMO
Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. Although the cornerstone of prenatal management of opioid dependence is opioid maintenance therapy, the ideal agent has yet to be definitively established. Pharmacologic management of NAS is also highly variable and may include an opioid, barbiturate, and/or α-agonist. Genetic factors appear to be associated with the incidence and severity of NAS. Establishing pharmacogenetic risk factors for the development of NAS has the potential for creating opportunities for "personalized genomic medicine" and novel, individualized therapeutic interventions.
Assuntos
Agonistas alfa-Adrenérgicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Barbitúricos/uso terapêutico , Síndrome de Abstinência Neonatal , Transtornos Relacionados ao Uso de Opioides/terapia , Complicações na Gravidez/terapia , Feminino , Humanos , Recém-Nascido , Conduta do Tratamento Medicamentoso , Síndrome de Abstinência Neonatal/diagnóstico , Síndrome de Abstinência Neonatal/etiologia , Síndrome de Abstinência Neonatal/genética , Síndrome de Abstinência Neonatal/terapia , Tratamento de Substituição de Opiáceos/métodos , Variantes Farmacogenômicos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/prevenção & controleRESUMO
OBJECTIVES: To compare the duration of opioid treatment and length of stay among infants treated for neonatal abstinence syndrome (NAS) by using a pilot buprenorphine vs conventional methadone treatment protocol. STUDY DESIGN: This retrospective cohort analysis evaluated infants who received pharmacotherapy for NAS at 6 hospitals in Southwest Ohio from January 2012 through August 2014. A single neonatology provider group used a standardized methadone protocol across all 6 hospitals. However, at one of the sites, infants were managed with a buprenorphine protocol unless they had experienced chronic in utero exposure to methadone. Linear mixed models were used to calculate adjusted mean duration of opioid treatment and length of inpatient hospitalization with 95% CIs in infants treated with oral methadone compared with sublingual buprenorphine. The use of adjunct therapy was examined as a secondary outcome. RESULTS: A total of 201 infants with NAS were treated with either buprenorphine (n = 38) or methadone (n = 163) after intrauterine exposure to short-acting opioids or buprenorphine. Buprenorphine therapy was associated with a shorter course of opioid treatment of 9.4 (CI 7.1-11.7) vs 14.0 (12.6-15.4) days (P < .001) and decreased hospital stay of 16.3 (13.7-18.9) vs 20.7 (19.1-22.2) days (P < .001) compared with methadone therapy. No difference was detected in the use of adjunct therapy (23.7% vs 25.8%, P = .79) between treatment groups. CONCLUSION: The choice of pharmacotherapeutic agent is an important determinant of hospital outcomes in infants with NAS. Sublingual buprenorphine may be superior to methadone for management of NAS in infants with select intrauterine opioid exposures.
Assuntos
Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Metadona/uso terapêutico , Síndrome de Abstinência Neonatal/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Analgésicos Opioides/efeitos adversos , Protocolos Clínicos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Tempo de Internação , Modelos Lineares , Masculino , Síndrome de Abstinência Neonatal/etiologia , Ohio , Transtornos Relacionados ao Uso de Opioides/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the efficacy of a universal maternal drug testing protocol for all mothers in a community hospital setting that experienced a 3-fold increase in neonatal abstinence syndrome (NAS) over the previous 5 years. STUDY DESIGN: We conducted a retrospective cohort study between May 2012 and November 2013 after the implementation of universal maternal urine drug testing. All subjects with positive urine tests were reviewed to identify a history or suspicion of drug use, insufficient prenatal care, placental abruption, sexually transmitted disease, or admission from a justice center, which would have prompted urine testing using our previous risk-based screening guidelines. We also reviewed the records of infants born to mothers with a positive toxicology for opioids to determine whether admission to the special care nursery was required. RESULTS: Out of the 2956 maternal specimens, 159 (5.4%) positive results were recorded. Of these, 96 were positive for opioids, representing 3.2% of all maternity admissions. Nineteen of the 96 (20%) opioid-positive urine tests were recorded in mothers without screening risk factors. Seven of these 19 infants (37%) required admission to the special care nursery for worsening signs of NAS, and 1 of these 7 required pharmacologic treatment. CONCLUSION: Universal maternal drug testing improves the identification of infants at risk for the development of NAS. Traditional screening methods underestimate in utero opioid exposure.
Assuntos
Analgésicos Opioides/efeitos adversos , Síndrome de Abstinência Neonatal/diagnóstico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Medicamentos sob Prescrição/efeitos adversos , Adulto , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Síndrome de Abstinência Neonatal/epidemiologia , Síndrome de Abstinência Neonatal/etiologia , Ohio/epidemiologia , Transtornos Relacionados ao Uso de Opioides/complicações , Gravidez , Complicações na Gravidez , Prevalência , Curva ROC , Estudos RetrospectivosAssuntos
Analgésicos Opioides/efeitos adversos , Troca Materno-Fetal , Síndrome de Abstinência Neonatal/diagnóstico , Síndrome de Abstinência Neonatal/terapia , Transtornos Relacionados ao Uso de Opioides , Complicações na Gravidez , Feminino , Humanos , Recém-Nascido , Síndrome de Abstinência Neonatal/etiologia , GravidezRESUMO
Visando a analisar o uso de maconha e opiáceos durante a gestação e suas consequências, tanto na formação como no futuro desenvolvimento da criança, realizou-se uma revisão crítica da literatura, com foco nos efeitos deletérios dessas drogas no recém-nato. Muitas dúvidas ainda não foram sanadas referentes à ação das drogas e o reflexo no concepto. Foram observadas coincidências entre o uso de maconha e o mau desenvolvimento do tubo neural do recém-nato, além de possíveis anencefalias. Em relação à ação dos opiáceos durante a gestação, foi observado um maior número de partos prematuros, bebês nascidos com baixo peso, com menor circunferência craniana e menor estatura
Aiming at analyzing the marijuana and opioids use during pregnancy and their consequences both in formation and in the future development of the child, a critic review of the literature was carried out focusing on the deleterious effects of these drugs in the recent born. Many questions have not been answered referring to the action of the drug and its reflection on the concept. It had been observed a relationship between use of marijuana and the poor development of the neural tube of the newly born and possible anencephalies. In relation to the opioids outcomes during pregnancy, an increase of premature births, babies born with low-birth weight, small cephalic circumference, and lower height were observed