heroin and Neonatal-Abstinence-Syndrome

This manuscript provides an overview of the current scientific literature on the impact of maternal drug use, specifically opioids and cocaine, during pregnancy on the acute and long-term outcomes of infants and toddlers from birth through age 3 years. Emphasis with regard to opioids is placed on heroin and opioid substitutes used to treat opioid addiction, including methadone, which has long been regarded as the standard of care in pregnancy, and buprenorphine, which is increasingly being investigated and prescribed as an alternative to methadone. Controlled studies comparing methadone at high and low doses, as well as those comparing methadone with buprenorphine, are highlighted and the diagnosis and management of neonatal abstinence syndrome is discussed. Over the past two decades, attention of the scientific and lay communities has also been focused on the potential adverse effects of cocaine and crack cocaine, especially during the height of the cocaine epidemic in the United States. Herein, the findings are summarized from prospective studies comparing cocaine-exposed with non-cocaine-exposed infants and toddlers with respect to anthropometric growth, infant neurobehavior, visual and auditory function, and cognitive, motor, and language development. The potentially stigmatizing label of the so-called "crack baby" preceded the evidence now accumulating from well-designed prospective investigations that have revealed less severe sequelae in the majority of prenatally exposed infants than originally anticipated. In contrast to opioids, which may produce neonatal abstinence syndrome and infant neurobehavioral deficits, prenatal cocaine exposure appears to be associated with what has been described as statistically significant but subtle decrements in neurobehavioral, cognitive, and language function, especially when viewed in the context of other exposures and the caregiving environment which may mediate or moderate the effects. Whether these early findings may herald more significant learning and behavioral problems during school-age and adolescence when the child is inevitably confronted with increasing social and academic challenges is the subject of ongoing longitudinal research.

Topics: Buprenorphine; Child Development; Child, Preschool; Cocaine; Cocaine-Related Disorders; Female; Heroin; Humans; Infant; Infant, Newborn; Male; Methadone; Neonatal Abstinence Syndrome; Pregnancy; Prenatal Exposure Delayed Effects; Substance-Related Disorders

Neonatal abstinence syndrome (NAS) is suffered by infants withdrawing from substances on which they have become physically dependent after in utero exposure. They may require prolonged treatment and spend weeks or even months in hospital. A wide range of drugs have been used to treat NAS. The efficacy of few, however, have been adequately investigated. Evidence suggests that opioids are the most appropriate, at least in infants exposed to diamorphine or methadone. In all "head to head" trials, diazepam has been shown to be ineffective. Morphine and methadone are currently the most commonly prescribed opioids to treat NAS, but randomised trials have not been undertaken to determine which is the more beneficial. Many infants with NAS have been exposed to multiple substances in utero. Further research is required into whether a single opiate or a multiple drug regimen is the best option for such patients.

Topics: Clinical Trials as Topic; Drug Therapy, Combination; Heroin; Humans; Infant, Newborn; Methadone; Morphine; Narcotics; Neonatal Abstinence Syndrome; Seizures; Sucking Behavior

Topics: Cocaine; Drug Administration Schedule; Female; Germany; Heroin; HIV Infections; HIV Protease Inhibitors; Hospitalization; Humans; Infant, Newborn; Methadone; Narcotics; Neonatal Abstinence Syndrome; Patient Compliance; Pregnancy; Substance Abuse, Intravenous

In the twenty years since the first case of neonatal drug addiction (resulting from the mother's use during pregnancy of morphine, heroin, methadone, cocaine) was referred to our attention, there has been a steady increase in the number of cases per year. Heroin alone or in association with methadone now represents the drug used by approximately 80% of addicted mothers. Over the past few years the mean age of mothers has increased; the number of drug users who do not appear to be addicts has also increased and a number of cases have lately been discovered only on the basis of neonatal symptoms, without any previous anamnestic indication. Neonatal abstinence syndrome (NAS) is the most striking effect of fetal exposure to drugs. Symptoms are easily recognised; pharmacological treatment can consist of either sedatives or replacement drugs whose dosage depends on the severity of withdrawal symptoms evaluated using a score system. NAS symptoms are usually resolved within a few days although some signs, especially irritability and tremors, may persist until 3 months of age. The main concern at present regards the future of these neonates. The most severe risk to which they are exposed, after HIV infection, is social; during the past few years in over 50% of cases parental authority has been suspended by the juvenile court. No long-term neurologic or cognitive deficits are directly associated with heroin or methadone use during pregnancy.

Topics: Female; Heroin; Humans; Infant, Newborn; Methadone; Narcotics; Neonatal Abstinence Syndrome; Pregnancy

This paper reviews the literature regarding the development of children up to age 6 years who were born to mothers addicted to heroin or methadone. These children are compared with children born to nonaddicted mothers to determine whether there were any differences between the two groups related to maternal drug addiction. This paper discusses the obstetrical and medical complications associated with maternal drug addiction and their effects on the prognosis of the infant at delivery.

Topics: Child; Child Behavior Disorders; Child, Preschool; Developmental Disabilities; Female; Heroin; Humans; Infant; Infant, Newborn; Methadone; Neonatal Abstinence Syndrome; Pregnancy

In order to investigate the effects of exposure to buprenorphine compared with methadone during pregnancy, a prospective multicenter study was conducted in collaboration with maternity hospitals, maintenance therapy centers, and general practitioners involved in addiction care. Ninety pregnant women exposed to buprenorphine and 45 to metadone were selected for the study.. During pregnancy, some women were exposed to illicit agents: cannabis (42% in the buprenorphine group vs. 58% in the methadone-treated group), heroin (17% vs. 44%), or cocaine (3% vs. 11%). Pregnancies ended in 85 vs. 40 live births, one vs. two stillbirths, two vs. one spontaneous abortion, two vs. one voluntary termination, and one vs. one medical termination in the buprenorphine and the methadone groups, respectively. Newborns had a birth weight of 2,892 ± 506 g (buprenorphine) vs. 2,731 ± 634 g (methadone) and a body length of 47.6 ± 2.5 cm vs. 47.1 ± 3 cm. 18.8% vs. 10% of newborns were delivered before 37 weeks of amenorrhea. Neonatal withdrawal syndrome occurred more frequently in the methadone group (62.5% vs. 41.2, p = 0.03). After adjustment for heroin exposure in late pregnancy, rates of neonatal withdrawal were no longer different between the methadone and buprenorphine groups. Twenty-one babies (84%) in the methadone group and 20 (57%) in the buprenorphine group (p = 0.03) required opiate treatment.. We did not observe more frequent malformations or cases of withdrawal syndrome in the buprenorphine group than in the methadone-treated group. Buprenorphine appears to be as safe as the currently approved substitute methadone considered to date as the reference treatment for pregnant opioid-dependent women.

Topics: Adult; Analgesics, Opioid; Birth Weight; Buprenorphine; Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Methadone; Narcotics; Neonatal Abstinence Syndrome; Opiate Substitution Treatment; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prospective Studies

To determine if oral clonidine would reduce the duration of opioid detoxification for neonatal abstinence syndrome.. Infants with intrauterine exposure to methadone or heroin and neonatal abstinence syndrome (2 consecutive modified Finnegan scores of > or =9) were enrolled at 2 hospitals during 2002-2005 and followed until final hospital discharge. All enrolled infants (80) received oral diluted tincture of opium according to a standardized algorithm and were randomly assigned to receive oral clonidine (1 microg/kg every 4 hours) (40 infants) or placebo (40 infants). Primary outcome was duration of opioid therapy. Secondary outcomes included the amount of opium required to control symptoms, number of treatment failures, and differences in blood pressure, heart rate, and oxygen saturation.. The median length of therapy was 27% shorter in the clonidine group (11 [95% confidence interval: 8-15 days]) than in the placebo group (15 days [95% confidence interval: 12-17 days]). In the clonidine group, 7 infants required restarting opium after initial discontinuation versus none in the placebo group, with the total length of treatment/observation remaining significantly less in the clonidine group. Higher dosages of opium were required by 40% of the infants in the placebo group versus 20% in the clonidine group. Treatment failures occurred in 12.5% of the infants in the placebo group versus none in the clonidine group. Hypertension, hypotension, bradycardia, or desaturations did not occur in either group. Three infants in the clonidine group died as a result of myocarditis, sudden infant death syndrome, and homicide, all after hospital discharge and before 6 months of age.. In this randomized, double-blind trial, adding clonidine to standard opioid therapy for detoxification from in utero exposure to methadone or heroin reduced the duration of pharmacotherapy for neonatal abstinence without causing short-term adverse cardiovascular outcomes. A larger trial is indicated to determine long-term safety.

Topics: Adrenergic alpha-Agonists; Analgesics, Opioid; Blood Pressure; Clonidine; Drug Therapy, Combination; Female; Heart Rate; Heroin; Humans; Infant, Newborn; Male; Methadone; Neonatal Abstinence Syndrome; Opium; Prospective Studies; Treatment Outcome

The aim of the study was to evaluate the effect of substitution therapy in heroin addicted pregnant women on the course of pregnancy, perinatal outcomes and course of the neonatal abstinence syndrome.. A five-year randomised prospective comparative study. The study was carried out in the period of 2002-2007. The group of patients included 147 i.v. heroin-addicted pregnant women. All of them were outpatients of our Perinatal Care Unit. Their daily dose of heroin was approximately lg. Later, 30 women were disqualified from the study for breaking the randomised criteria engagement. The substitution therapy in women who agreed to undergo it, started during the I. trimester of pregnancy. Finally, 47 heroin, 32 methadone and 38 buprenorphine addicted women were enrolled in the study. Birthweight of newborns was compared with the national birthweight tables. Severity and duration of neonatal abstinence syndrome (NAS) were evaluated by Finnegan s score scale.. None of the women delivered before the end of 34th gestational week. We did not encounter any perinatal death or developmental defect. The lowest birthweight, the highest number of newborns with IUGR and the most numerous placental changes were found in the group of heroin-addicted women. The differences compared to the two groups receiving substitution therapy were statistically significant (p < 0.05). The severity and course of NAS were the most severe (p < 0.001) in newborns of women from the methadone group.. Comparison of the groups of outpatients is in many ways questionable because of the restricted possibility of the patients' control. The lifestyle of addicted women has the same impact as the drug use alone. This is probably the main reason for differences in some of the monitored parameters between individual groups. Based on our results we can state that substitution therapy provides pregnant women with the possibility of social stabilization and adequate prenatal care. substitution therapy decreases the street heroin consumption. Methadone notably protracts the newborn's abstinence syndrome. With regard to this fact, attention has been recently focused on substitution with buprenorphine that seems to be from this viewpoint a more considerate option.

Topics: Adult; Birth Weight; Buprenorphine; Female; Fetal Growth Retardation; Heroin; Heroin Dependence; Humans; Infant, Newborn; Life Style; Methadone; Narcotics; Neonatal Abstinence Syndrome; Outpatients; Postpartum Period; Pregnancy; Pregnancy Outcome; Prospective Studies; Severity of Illness Index

A partially randomised, controlled trial was performed to test the hypothesis that opiate exposed infants treated with diluted tincture of opium (DTO) and phenobarbital would have better neurobehavioral scores than infants treated with DTO alone. Compared with those treated with DTO alone (n = 15), infants treated with DTO and phenobarbital (n = 17) were more interactive, had smoother movements, were easier to handle, and less stressed. Dual treatment results in improved neurobehavioral organisation during the first three weeks of life, which may indicate a more rapid recovery from opiate withdrawal.

Topics: Analgesics, Opioid; Drug Therapy, Combination; Heroin; Humans; Hypnotics and Sedatives; Infant Behavior; Infant, Newborn; Methadone; Neonatal Abstinence Syndrome; Opium; Phenobarbital; Psychomotor Performance; Treatment Outcome

The purpose of this study was to test the hypothesis that treatment of neonatal opiate withdrawal (NOW) in the term infant with diluted tincture of opium (DTO) and phenobarbital was superior to treatment with DTO alone.. This was a partially randomized, controlled trial in which 20 term infants exposed to methadone and/or heroin in utero were studied. The severity of NOW was assessed by using the Finnegan scoring system. Infants were assigned to either DTO and placebo (n = 10) or DTO and phenobarbital (n = 10) when medication was required. The primary outcome variable was the duration of hospitalization. Severity of withdrawal and hospital cost were secondary outcome variables.. There were no significant differences in the gestational age, growth variables, maternal methadone dose, or age at enrollment between the 2 groups. The duration of hospitalization was reduced by 48% (79-38 days) (P <.001) and hospital cost per patient reduced by $35,856 (P <.001) for the DTO and phenobarbital group. Furthermore, these infants spent less time with severe withdrawal (P <.04), more time with mild withdrawal (P <.03), and required a lower maximum daily DTO dose (P <.009) when compared with the DTO-only group. The average duration of outpatient phenobarbital use was 3.5 months.. The combined use of DTO and phenobarbital resulted in a shorter duration of hospitalization, less severe withdrawal, and reduced hospital cost. This combination may be a preferred regimen for the treatment of NOW.

Topics: Analgesics, Opioid; Drug Therapy, Combination; Heroin; Hospital Costs; Humans; Hypnotics and Sedatives; Infant, Newborn; Length of Stay; Methadone; Neonatal Abstinence Syndrome; Opium; Phenobarbital; Statistics, Nonparametric

We describe the neonatal course of 30 antenatal narcotic-exposed newborns, half of whom were randomly assigned to nonoscillating waterbeds and half to conventional bassinets. The infants were comparable at birth regarding drug exposure, ethnicity, maternal medical factors, gestational age, growth, and severity of withdrawal at the time of onset. Evaluation of total and subscores of the abstinence syndrome showed a lower total score and a significantly lower central nervous system subscore on day 5 for infants on waterbeds. The infants on waterbeds required less medication to control symptoms. The waterbed group demonstrated a significantly earlier onset of consistent weight gain as compared with the control group. This study demonstrates that nonoscillating waterbeds are an inexpensive and effective component of supportive therapy in the care of narcotic-exposed neonates.

Topics: Beds; Cocaine; Heroin; Humans; Infant Care; Infant, Newborn; Methadone; Methamphetamine; Neonatal Abstinence Syndrome; Random Allocation

The purpose of this study was to describe an identified association between necrotizing enterocolitis (NEC) and prenatal opioid exposure with neonatal abstinence syndrome (NAS) in late preterm and full-term neonates.. In this single-center retrospective cohort study, we analyzed inborn neonates with the diagnosis of NEC discharged from 2012 through 2017. We compared infants with NEC > 35 weeks' gestation to those with NEC<35 weeks' gestation. We compared gestational age, birth weight, age of onset of symptoms, and incidence of prenatal drug exposure between groups. Significance was determined using Mann-Whitney and Fisher's exact tests.. Over the study period, 23 infants were identified with NEC, 9 (39%) were babies > 35 weeks at birth and 14 (61%) < 35 weeks. Those > 35 weeks had a higher birth weight, earlier onset of symptoms, and a higher percentage of prenatal exposure to opioids compared to those < 35 weeks' gestation. We further described seven infants with late gestational age onset NEC associated with prenatal opioid exposure.. In this cohort of infants with NEC discharged over a 6 year period we found a higher than expected percentage of infants born at a later gestational age. We speculate that prenatal opioid exposure might be a risk factor for NEC in neonates born at > 35 weeks.

Topics: Analgesics, Opioid; Buprenorphine; Cohort Studies; Enterocolitis, Necrotizing; Female; Fetal Blood; Gestational Age; Heroin; Humans; Infant, Newborn; Infant, Premature; Male; Methadone; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Retrospective Studies

BACKGROUND With the increasing prevalence of substance use in pregnancy, the rates of neonatal abstinence syndrome (NAS) are dramatically increasing. There is little information on the use of multiple substances in adults, even less so of polysubstance abuse during pregnancy and the consequences for the fetus as well as the mother. CASE REPORT A newborn male born at 35 weeks presented post-delivery with hips bilaterally dislocated and hyperflexed. The patient's legs fully extended and their shoulders were bilaterally mid-flexed with arms fully extended. This neonate was also reported to have bilateral hearing and vision loss as well as NAS symptoms of high-pitched crying and respiratory distress. During pregnancy the mother in this case study admitted to using buprenorphine, benzodiazepines, gabapentin, and heroin. The consequences of using this combination has not been well studied in pregnancy. CONCLUSIONS The presented case had severe complications, likely due to maternal polysubstance use and poor prenatal care in pregnancy. Clonidine was used to control the NAS symptoms, ranitidine was used to treat the gastroesophageal reflux, and glycopyrronium bromide was used for the neonate's excessive secretions. After delivery, the patient was placed on a nasal noninvasive cannula for respiratory distress and was transferred to a different hospital for treatment of the more serious comorbid conditions.

Topics: Benzodiazepines; Buprenorphine; Female; Gabapentin; Heroin; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Male; Neonatal Abstinence Syndrome; Pregnancy; Prenatal Exposure Delayed Effects

Study aims to examine development in infants following prenatal heroin, methadone, and opioid exposure, which adversely affects central and autonomic nervous systems. Abrupt discontinuation results in neurologic and behavioral findings as Neonatal Abstinence Syndrome (NAS).. Following NAS treatment, 28 infants (mean age 55 days [range 21-98 days], 57% male) were assessed using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) Cognitive, Language, and Motor subscales. Outcomes were compared with a historical control.. Mean Language and Cognition scores were significantly lower (P < .001) in the NAS group. Distributions of scores for Language (P < .001) and Cognition (P = .022) were also significantly different between NAS and historical control groups.. Prenatal heroin, methadone, and other opioid exposure is associated with weaknesses in language and cognition. This information has important public health implications, drawing attention to an otherwise healthy infant population which may benefit from early intervention services.

Topics: Analgesics, Opioid; Child Development; Developmental Disabilities; Female; Heroin; Humans; Infant; Infant, Newborn; Male; Methadone; Neonatal Abstinence Syndrome; Neuropsychological Tests; Pregnancy; Prenatal Exposure Delayed Effects

Topics: Heroin; Humans; Infant, Newborn; Methadone; Neonatal Abstinence Syndrome; Perinatal Care; Public Health; Severity of Illness Index

We describe a suspicious case involving a previous heroin addict and her newborn child experiencing symptoms suggestive of withdrawal. Therapeutic drug monitoring was used to determine whether in utero exposure took place.

Topics: Diazepam; Drug Monitoring; Female; Heroin; Heroin Dependence; Humans; Hypnotics and Sedatives; Infant, Newborn; Male; Neonatal Abstinence Syndrome; Pregnancy

Heroin availability and purity decreased precipitously in Australian markets between 2000 and 2001. This led to increased use of non-opiate drugs in the general community but whether pregnant drug users and their newborn infants were affected remains unknown.. To determine if perinatal drug exposure and outcomes are affected by changes in street drug availability.. Retrospective review was carried out of known drug-exposed mothers delivering live-born infants at the Royal Hospital for Women, Randwick, Australia (n = 316). Study periods were divided into preshortage (A = 1998-2000, n = 79), shortage (B = 2001-2002, n = 92) and post-shortage (C = 2003-2006, n = 122) periods. Cannabis-only users were excluded (n = 23).. The percentage of confined women who admitted to using heroin decreased significantly (65%(A) vs 34%(B), P < 0.01) as did women on methadone programmes (90%(A), 80%(B), 75%(C), P = 0.024). The use of cocaine (7% (A) vs 33% (B), P = 0.031) and amphetamines (4% (A) vs 22% (C), P = 0.01), tripled. Most infants were born full-term and healthy but the duration of infant hospitalisation increased significantly from (median [interquartile range]) 8 [10, 38](A) to 13 [7, 23](C) days (P < 0.01). Approximately 50% of infants required withdrawal treatment but more needed phenobarbitone as an adjunct to morphine during the shortage (4/80 (0.5%) vs 15/93 (16%), P = 0.026), probably because of increased exposure to non-opiate drugs.. The types of drugs used by pregnant drug users follow street trends and may affect infant hospitalisation and withdrawal treatment. Of concern is the rise in amphetamine-use and there needs to be increased vigilance for similar trends, especially in previously unidentified drug users.

Topics: Australia; Drug Users; Female; Heroin; Humans; Illicit Drugs; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Retrospective Studies; Substance-Related Disorders; Time Factors

The aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country.. Data on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997-2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group.. During the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score < or = 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers.. Addiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

Topics: Adult; Apgar Score; Birth Weight; Croatia; Female; Heroin; Heroin Dependence; Humans; Incidence; Infant Mortality; Infant, Newborn; Maternal Exposure; Methadone; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pregnancy Outcome

Heroin-assisted treatment (HAT) is a new form of treatment for heroin-dependent patients not responding to conventional interventions such as methadone maintenance treatment. No pregnancies or births under HAT have been reported until now.. The pregnancy course of a 31-year-old severely dependent multi-morbid woman receiving HAT and the birth of a healthy baby after premature delivery is described. HAT helped to reduce the use of illicit substances both before and during pregnancy. The neonatal abstinence syndrome was clinically well compensated.. HAT seems to be feasible in pregnant women and normal birth is possible under HAT, which therefore may act as a harm reduction measure for polydrug-using pregnant women not responding to methadone maintenance treatment.

Topics: Adult; Female; Heroin; Humans; Infant, Newborn; Male; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Substance-Related Disorders

To evaluate the effect of rooming-in (rather than standard nursery care) on the incidence and severity of neonatal abstinence syndrome among opioid-exposed newborns and on the proportion of mothers who retain custody of their babies at hospital discharge.. Retrospective cohort study.. Lower mainland in southwestern British Columbia.. We selected 32 women in the city of Vancouver known to have used heroin or methadone during pregnancy between October 2001 and December 2002. Comparison groups were a historical cohort of 38 women in Vancouver and a concurrent cohort of 36 women cared for in a neighbouring community hospital.. Need for treatment with morphine, number of days of treatment with morphine, and whether babies were discharged in the custody of their mothers.. Rooming-in was associated with a significant decrease in need for treatment of neonatal abstinence syndrome compared with the historical cohort (adjusted relative risk [RR] 0.40, 95% confidence interval [CI] 0.20 to 0.78) and the concurrent cohort (adjusted RR 0.39, 95% CI 0.20 to 0.75). Rooming-in was also associated with shorter newborn length of stay in hospital compared with both comparison groups. Newborns who roomed in at BC Women's Hospital were significantly more likely to be discharged in the custody of their mothers than babies in the historical cohort (RR 2.23, 95% CI 1.43 to 3.98) or the concurrent cohort (RR 1.52, 95% CI 1.15 to 2.53) were.. Rooming-in might ease opioid-exposed newborns' transition to extrauterine life and promote more effective mothering.

Topics: Adult; Breast Feeding; British Columbia; Child Custody; Cohort Studies; Comorbidity; Female; Heroin; Humans; Infant, Newborn; Length of Stay; Methadone; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prevalence; Rooming-in Care; Smoking; Socioeconomic Factors; Substance-Related Disorders

Opiate use in pregnancy is on the increase. There are a number of complications associated with this problem but current data from UK centres are sparse.. A retrospective study.. A North of England Hospital.. Maternal and neonatal case records were studied and a standard data set completed.. Maternal and neonatal outcomes were classified by the woman's drug usage at the end of pregnancy.. One hundred and ten babies born to 108 women were studied and 41% had evidence of previous exposure to the hepatitis C virus. Women who took heroin in later pregnancy were significantly more likely than women who were stabilised on methadone to have a baby who needed morphine (40% versus 19%), had higher mean maximum neonatal abstinence scores (NAS) (5.8 versus 4.7) and stayed in the neonatal unit significantly longer (mean 17.2 days versus 11.8 days). There were two neonatal deaths and the overall rate of prematurity was 29%.. The outcome for pregnancy in women who use opiates is complicated by high rates of prematurity and neonatal death. Women who used heroin in later pregnancy had babies who developed more severe NAS and needed a longer hospital stay than women who used only methadone.

Topics: Adult; England; Female; Heroin; Humans; Infant, Newborn; Male; Medical Records; Methadone; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Retrospective Studies

Topics: Adult; Empathy; Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Male; Neonatal Abstinence Syndrome; Nurse-Patient Relations; Nurse's Role; Spirituality; Women's Health

At a follow-up clinic for infants of opiate-dependent mothers it was noted that more infants than expected developed strabismus. This study aimed to assess the prevalence of strabismus and the need for active strabismus surveillance in this population.. Consecutive infants of opiate-dependent mothers born over an 18 mo period were recalled for ophthalmological assessment by an ophthalmologist and orthoptist. Those unable to attend were surveyed by telephone using a questionnaire.. 49 (69%) of the 71 eligible infants were recalled at a mean age of 21 mo (range 6-39); 29 had a full ophthalmological examination and the remaining 20 completed the questionnaire only. Seven (14%) of the 49 recalled infants had strabismus on examination; 4 needed glasses or patching. A further seven (14%) had a history of intermittent strabismus but declined formal examination. Another child had significant hypermetropia without strabismus. The mean age at which strabismus was observed was 8.3 mo (range birth to 19 mo). The presence of strabismus was not significantly influenced by conditions at birth, maternal drug doses, family history or need for or duration of abstinence treatment.. The rate of strabismus in infants of opiate-dependent mothers was at least 10 times that in the general population. As attendance at follow-up is often poor, paediatricians should be aware of the association to encourage opportunistic assessment and ophthalmological surveillance of this population.

Topics: Australia; Codeine; Cross-Sectional Studies; Female; Heroin; Humans; Infant; Infant, Newborn; Male; Maternal-Fetal Exchange; Methadone; Morphine; Narcotics; Neonatal Abstinence Syndrome; Neonatal Screening; Opioid-Related Disorders; Pregnancy; Prenatal Exposure Delayed Effects; Prevalence; Severity of Illness Index; Strabismus

Topics: Child Development; Cocaine; Female; Growth Disorders; Heroin; Hospitalization; Humans; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Substance-Related Disorders

Topics: Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Exposure Delayed Effects

To determine whether maternal methadone dosage affects duration and degree of neonatal narcotic withdrawal.. This was a retrospective cohort study of pregnant women with opioid addiction who delivered live-born singletons between April 1990 and April 2001. Inpatient detoxification or outpatient methadone maintenance therapy was offered. Women who had a positive drug screen or whose neonate tested positive for opioids were considered to be supplementing. We evaluated indices of neonatal withdrawal according to the maximum daily methadone dosage in the last week of pregnancy.. Seventy women with opioid addiction were followed. Median methadone dosage was 20 mg (range 0-150 mg), and 32 infants (46%) were treated for narcotic withdrawal. Among women who received less than 20 mg per day, 20-39 mg per day, and at least 40 mg per day of methadone, treatment for withdrawal occurred in 12%, 44%, and 90% of infants, respectively (P < 0.02). Methadone dosage was also correlated with both duration of neonatal hospitalization and neonatal abstinence score (r(s) =.70 and.73 respectively, both P <.001). Neonates were more likely to experience withdrawal if their mothers were supplementing with heroin, 68% versus 35% (P =.01). Regardless of supplementation, there was a significant relationship between methadone dosage and neonatal withdrawal (P <.05).. Maternal methadone dosage was associated with duration of neonatal hospitalization, neonatal abstinence score, and treatment for withdrawal. Heroin supplementation did not alter this dose-response relationship. In selected pregnancies, lowering the maternal methadone dosage was associated with both decreased incidence and severity of neonatal withdrawal.

Topics: Adult; Analysis of Variance; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Gestational Age; Heroin; Humans; Infant, Newborn; Maternal-Fetal Exchange; Methadone; Neonatal Abstinence Syndrome; Opioid-Related Disorders; Pregnancy; Probability; Retrospective Studies; Risk Assessment; Substance Withdrawal Syndrome; Time Factors

To determine the neonatal outcome in the form of use of morphine and triclofos to treat the neonatal abstinence syndrome following maternal opiate use in late pregnancy.. Retrospective case study of 51 pregnancies associated with maternal opiate use between January 1992 and December 1997.. There were 51 pregnancies which resulted in 51 live births. In the third trimester 22 women took methadone only, 19 women used heroin and 10 women stopped opiate use during pregnancy. Babies of methadone using mothers were less likely to be treated with morphine or triclofos than heroin using women. Morphine, triclofos use was more common in high dose methadone users compared with low users.. Successful methadone substitution compared with continued heroin use results in reduced morphine and triclofos use in the babies exposed.

Topics: Analgesics, Opioid; Female; Heroin; Humans; Infant, Newborn; Morphine; Neonatal Abstinence Syndrome; Organophosphates; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Retrospective Studies; Substance-Related Disorders

In the present investigation we were interested to study the possible role of in-utero exposure to heroin and of the home environmental in the etiology of long-term developmental problems in children born to heroin-dependent parents in comparison to matched controls. The children were examined at .5-6 years of age by a developmental pediatrician and a developmental psychologist using, for the children up to 2.5 years of age, the Bayley Developmental Scales, and for children aged 3-6 years the McCarthy Scales for Children's Abilities. We examined 83 children born to heroin-dependent mothers, and compared the results to those of 76 children born to heroin-dependent fathers and to three control groups; 50 children with environmental deprivation, 50 normal children from families of moderate or high socioeconomic class, without environmental deprivation, and 80 healthy children from kindergartens in Jerusalem. There were five children (6.0%) with significant neurological damage among the children born to heroin-dependent mothers and six (7.9%) children among those born to heroin-dependent fathers. The children born to heroin-dependent mothers had a lower birth weight and a lower head circumference at examination when compared to controls. The children born to heroin-dependent parents also had a high incidence of hyperactivity, inattention, and behavioral problems. The lowest DQ or IQ among the children with cognitive levels above 70 was found in the children with environmental deprivation, next was the DQ or IQ of children born to heroin-dependent fathers, then the DQ or IQ of the children born to heroin-dependent mothers. When the children born to heroin-dependent mothers were divided to those that were adopted at a very young age and to those raised at home, the adopted children were found to function similarly to the controls while those not adopted functioned significantly lower. Our results show that the developmental delay and behavioral disorders observed among children born to drug-dependent parents raised at home may primarily result from severe environmental deprivation and the fact that one or both parents are addicted. The specific role of the in-utero heroin exposure in the determination of the developmental outcome of these children (if they do not have significant neurological damage), seems to be less important in comparison to the home environment.

Topics: Abnormalities, Drug-Induced; Birth Weight; Case-Control Studies; Child; Child of Impaired Parents; Child, Preschool; Developmental Disabilities; Family Health; Fathers; Female; Growth; Heroin; Heroin Dependence; Humans; Infant; Infant, Newborn; Israel; Male; Mothers; Neonatal Abstinence Syndrome; Pregnancy; Prenatal Exposure Delayed Effects; Psychosocial Deprivation; Sex Ratio; Social Class

A prospective longitudinal study on the development of children of drug-dependent mothers who used combinations of cocaine, heroin and methadone during pregnancy was carried out in Amsterdam. The children and a contrast reference group were followed from birth to the age of 5 1/2 years. Cognitive functioning was assessed at 3 1/2, four, 4 1/2 and 5 1/2 years. The children of drug-dependent mothers repeatedly showed delays in cognitive functioning at preschool-age. Individual difficulties, as well as differences in developmental patterns over time, were found most clearly when facets of language development formed part of the assessments. Intervention programmes should focus on improvements of early language development and communication, in addition to the children's ability to adapt to task situations.

Topics: Child, Preschool; Cocaine; Cognition; Female; Heroin; Humans; Infant; Infant, Newborn; Language; Male; Methadone; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prospective Studies; Psychological Tests; Risk Factors; Social Support; Substance-Related Disorders

Neonatal abstinence syndrome (NAS) is one of the most frequent manifestations in the neonates of drug-addicted mothers. It is caused by the abrupt interruption of the transplacentar passage of drugs from the mother to the fetus. The aim of this study was to evaluate the correlation between drugs taken during pregnancy and NAS. Data were examined relating to 223 neonates born during 1975-1992 to drug-addict mothers. Neonates were subdivided into four groups according to the maternal toxicological profile. It was thus possible to observe that there is a greater prevalence of NAS in cases of polypharmacomania and that it gradually diminishes in the children of heroin addicts and those receiving methadone treatment. Moreover, the intensity of the syndrome is correlated to the high doses of methadone and/or heroin. In the group of neonates whose mothers had complied with the methadone treatment protocol, the severity of NAS was proportional to the dose taken by the mother. In conclusion, the management of pregnant drug addicts following a controlled methadone treatment programme is accompanied by improved obstetric help and is the most suitable way of reducing perinatal complications and the prevalence of NAS.

Topics: Dose-Response Relationship, Drug; Female; Gestational Age; Heroin; Humans; Infant, Newborn; Maternal-Fetal Exchange; Methadone; Mothers; Neonatal Abstinence Syndrome; Pregnancy; Prenatal Exposure Delayed Effects; Substance-Related Disorders

Retrospectively, were tested maternal-neonatal factors of 47 newborn with neonatal abstinence syndrome comparing them with a control group of 100 newborn, during the period from 1985 to 1991. An average incidence of 6/1000 living newborn were affected by abstinence syndrome. The mothers were young (75%), smokers (74%), unemployed (80%), with a high rate of previous abortions (21%) and with a bad pregnancy control. Within our environment, abstinence syndrome increase has been detected among children of young gypsy mothers. Heroin (88%) was the most popular drug. Nevertheless a change has been noted in the last few years in the drug administration going from intravenous to the inhalational route. The duration of syndrome was less in the newborn whose mothers had inhaled heroin and in the premature newborn. It was proved that there was a high rate of HIV (40%), hepatitis B (23%), and syphilis markers (25%).

Topics: Adult; Chi-Square Distribution; Cocaine; Female; Heroin; HIV Seropositivity; Humans; Incidence; Infant, Newborn; Male; Methadone; Neonatal Abstinence Syndrome; Retrospective Studies; Socioeconomic Factors; Spain

Outcomes for 6 pregnant methadone-maintained opiate-dependent subjects in enhanced treatment were compared to those of 6 women receiving conventional methadone maintenance. Enhanced treatment consisted of weekly prenatal care, relapse prevention groups, thrice weekly urine toxicology screening with positive contingency awards for abstinence, and therapeutic child care during treatment visits in addition to treatment as usual. Treatment as usual included daily methadone, group counseling, and random urine toxicology screening. Study patients differed from the comparison group in three important ways, having fewer urine toxicology screens positive for illicit substances (59% vs. 76%), three times as many prenatal visits (8.8 vs. 2.7), and heavier infants (median birth weight, 2959 vs. 2344 grams). These results suggest that enhanced drug treatment can improve pregnancy outcome and, in particular, reduce low birth weight for this high-risk population.

Topics: Adult; Combined Modality Therapy; Female; Fetal Growth Retardation; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Infant, Newborn; Methadone; Neonatal Abstinence Syndrome; Outcome and Process Assessment, Health Care; Patient Care Team; Pregnancy; Pregnancy Complications; Prenatal Care; Recurrence; Social Environment; Substance Abuse Detection

The pre- and postnatal data of 20 pregnant heroin addicts and their neonates are described. 16 women were treated with methadone to prevent withdrawal symptoms. A relatively stabile prenatal condition with a decrease of complications was achieved. On the other hand, the neonates suffered from severe withdrawal symptoms including seizures in spite of intensive paediatric care and prophylactic treatment with barbiturates. After a mean follow-up of one to two years a relatively good neurological development of the children was observed.

Topics: Asphyxia Neonatorum; Cardiotocography; Dose-Response Relationship, Drug; Female; Fetal Growth Retardation; Heroin; Heroin Dependence; HIV Infections; Humans; Infant, Newborn; Methadone; Neonatal Abstinence Syndrome; Neurologic Examination; Pregnancy; Pregnancy Complications; Spasms, Infantile

Data on 178 term and 34 preterm infants born to methadone-maintained mothers were analyzed to assess the effects of neonatal opiate abstinence in infants of varying gestational ages. More mothers in the term group (79%) than in the preterm group (53%) had abused other drugs during pregnancy (p less than 0.001). Mean (+/- SD) gestational age was 39.5 weeks +/- 1.4 for term infants and 34.3 weeks +/- 2.6 for preterm infants. On the basis of a semiobjective symptom scoring scale, term infants had more severe abstinence symptoms and more prominent central nervous system manifestations than preterm infants. The severity of abstinence symptoms correlated with maternal methadone dosage in both term and preterm infants. Maternal multiple drug abuse (e.g., heroin, cocaine) did not influence severity of abstinence symptoms in either group. More term infants (145/178) than preterm infants (20/34) required treatment for these symptoms (p less than 0.005). In 13 of 178 term infants, compared with 1 of 34 preterm infants, abstinence-related seizures developed. Peak severity occurred 1 to 2 days earlier in term than in preterm infants. A less severe abstinence syndrome in preterm infants may be due to (1) developmental immaturity of either dendritic ramifications, specific opiate receptors, or neurotransmitter function, or (2) reduced total drug exposure during the intrauterine period.

Topics: Central Nervous System; Cocaine; Dose-Response Relationship, Drug; Gestational Age; Heroin; Humans; Infant, Newborn; Infant, Premature; Methadone; Narcotics; Neonatal Abstinence Syndrome; Prospective Studies; Severity of Illness Index

Infants of mothers who used methadone, heroin, cocaine and other drugs during pregnancy were compared with a group of control infants over the first 30 mths of life. Results of repeated examinations with the Bayley Scales of Infant Development showed a difference between the groups in mental development. No differences were found in a non-verbal version of the mental scale, but infants of drug dependent mothers seem to have specific difficulties in early language development. In psychomotor development, in behaviour during testing and on a questionnaire on activity, infants of drug dependent mothers did not differ from the comparison children.

Topics: Child Behavior Disorders; Child of Impaired Parents; Child, Preschool; Cocaine; Female; Follow-Up Studies; Heroin; Humans; Infant; Infant, Newborn; Language Development Disorders; Longitudinal Studies; Male; Methadone; Mother-Child Relations; Neonatal Abstinence Syndrome; Risk Factors

A revision of 16 newborns and their heroin-addicted mothers was carried out. The mean maternal age was 23.06 +/- 3.43 years, and mean duration of addiction was 3.07 +/- 1.43 years. The last dose of heroin was administered less than 24 hours prior to giving birth in every [corrected] case except one. Antenatal care was irregular and previous abortions were frequent. Two mothers had a history of syphilis, five had markers for anti-HIV antibodies. The mean duration of pregnancy was 37.8 +/- 2.28 weeks, and unknown in five cases. Mean birth weight was 2.715 +/- 281 g. Withdrawal symptoms were observed in 13 babies. Of these, 12 required treatment with phenobarbital and in 1 case with chlorpromazine as well. In 9 babies, hepatitis B prophylaxis was carried out and three had HIV antibodies.

Topics: Adult; Female; Heroin; Heroin Dependence; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Neonatal Abstinence Syndrome

The principal obstetrical and paediatric sequelae were studied in 22 heroin addicts who were followed up at Lariboisière Hospital in Paris between 1980 and 1984. The main effects were on the fetus with 45% showing growth retardation below the 10th percentile, 65% fetal distress, 9% prematurity; 33% had infections and 66% had the withdrawal syndrome. Because of this pathology a high number had to be transferred. Considering the period of study, HIV infection could not be evaluated. The most dramatic result seems to be the long-term effect on these children because only a third apparently live with their families and several suffer from abnormalities in psychomotor development.

Topics: Adult; Female; Fetal Distress; Fetal Growth Retardation; Heroin; Heroin Dependence; Humans; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications

Topics: Administration, Inhalation; Adolescent; Adult; Female; Heroin; Humans; Infant, Low Birth Weight; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Topics: Female; Heroin; Heroin Dependence; Humans; Infant, Newborn; Methadone; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications

The neuropsychological and behavioral status of children exposed to narcotics in utero was investigated using the Wechsler Intelligence Scale for Children-Revised, the Bender-Gestalt, the Quick Neurological Screening Test, and the Burks Behavior Rating Scales. The narcotic-exposed children scored significantly lower than control children on Performance and Full-Scale IQs and most of the performance subtests. They scored significantly in the more pathological direction on Hand Skill, Figure Recognition and Reproduction, and Behavioral Irregularities. The narcotic-exposed children were significantly lower on the neurological indicators of the Bender-Gestalt. They scored significantly in the more pathological direction on almost all of the behavioral variables. The children exposed to methadone in utero scored in the more pathological direction than those exposed to heroin so as to raise questions directed toward the societal and ethical implications of methadone treatment.

Topics: Adolescent; Child; Follow-Up Studies; Heroin; Humans; Infant, Newborn; Intelligence; Methadone; Neonatal Abstinence Syndrome; Neuropsychological Tests; Psychometrics; Substance-Related Disorders

In 50 infants born to women who continued to take heroin during all or part of their pregnancy the drug withdrawal symptoms were mild and were noted in 21 infants (42%). Only nine infants required treatment. Sudden infant death syndrome occurred in two infants at 4 and 6 months.

Topics: Adolescent; Adult; Female; Heroin; Humans; Infant, Newborn; Methadone; Narcotics; Neonatal Abstinence Syndrome; Pregnancy; Scotland; Sudden Infant Death

The effects of chronic addiction to, and withdrawal from, opiates on sleep have been described in experimental animals, in human adults and infants born to addicted mothers. These sleep alterations are seen through the first weeks of life. Thirteen maternally addicted babies were studied. Sleep samples were recorded and scored within a few days following birth and repeated 4 or 5 weeks later after recovery from the abstinence syndrome. A significant decrease in quiet sleep and increase of active sleep were found. The same alterations, although less marked, were observed in a follow up recording performed during the second month of life. Sleep alterations in addicted newborns could be related to central nervous system (CNS) distress caused by withdrawal. The authors however propose a perturbation of endogenous opiates subsequent to fetal addiction as a cause of sleep alterations.

Topics: Adult; Female; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Infant, Newborn; Male; Neonatal Abstinence Syndrome; Pregnancy; Sleep

Topics: Female; Heroin; Humans; Infant, Newborn; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Topics: Child Abuse; Confidentiality; Heroin; Humans; Infant, Newborn; Malpractice; Neonatal Abstinence Syndrome; United States

Topics: Cocaine; Heroin; Humans; Infant, Newborn; Neonatal Abstinence Syndrome