RSS-Feed abonnieren
DOI: 10.1055/s-0035-1549218
Maternal Methadone Treatment and Neonatal Abstinence Syndrome
Publikationsverlauf
20. Dezember 2014
12. Februar 2015
Publikationsdatum:
27. April 2015 (online)
![](https://www.thieme-connect.de/media/ajp/201511/lookinside/thumbnails/10-1055-s-0035-1549218_140393-1.jpg)
Abstract
Objective This article aims to describe neonatal outcomes, clinical correlates, and the rate for neonatal abstinence syndrome (NAS) for women on methadone maintenance therapy.
Methods This study is a retrospective review, which includes 119 mothers and 120 live newborns.
Results Methadone mothers tends to be white, single, on government insurance, with increased tobacco use (73%) and hepatitis C (11%). Prematurity increased (28%), and the term infant had a higher risk for admission for respiratory symptoms (22, 7%, p < 0.001). Overall, 78% newborns developed NAS, with the onset of symptoms 4.3 ± 2.9 days, and average length of stay of 36.7 ± 26.4 days. There was a decreased overall gestational age for those infants who did not have NAS (36, 38 weeks, p = 0.04). Overall, 56% had possible illicit drug supplementation. Self-reporting had a 59% negative predictive value with a positive drug screen. No difference in maternal methadone dosage and newborns with and without NAS. Increasing gestational age will increase the odds for NAS.
Conclusions Newborns are at higher risk for prematurity and admission for respiratory symptoms. Utilizing a 7-day observation period, 78% of newborns were diagnosed with NAS with a mean onset of symptoms of 4.3 days. There was no difference in methadone dosage between babies with and without NAS. Increasing gestational age increases the risk for NAS.
-
References
- 1 Hudak ML, Tan RC ; COMMITTEE ON DRUGS; COMMITTEE ON FETUS AND NEWBORN; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012; 129 (2) e540-e560
- 2 Behnke M, Smith VC ; Committee on Substance Abuse; Committee on Fetus and Newborn. Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics 2013; 131 (3) e1009-e1024
- 3 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
- 4 Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstet Gynecol 2011; 204 (3) 259.e1-259.e4
- 5 Johnson H. Florida trends in drug withdrawal syndrome in newborns by county and DCF region, 2005–2010. Florida Agency for Healthcare Administration. Substance abuse and mental health program office, State of Florida, FL: 2011
- 6 Paulozzi LJ, Jones CM, Mack KA, Rudd RA. Vital signs: Overdoses of prescription opioid pain relievers- United States, 1999–2008. MMWR 2011; 60: 869-872
- 7 Hayes MJ, Brown MS. Epidemic of prescription opiate abuse and neonatal abstinence. JAMA 2012; 307 (18) 1974-1975
- 8 Dole VP, Nyswander M. A medical treatment for diacethylmorphine (heroin) addiction. JAMA 1965; 193: 646-650
- 9 National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. Effective medical treatment of opiate addiction. JAMA 1998; 280 (22) 1936-1943
- 10 ACOG Committee on Health Care for Underserved Women; American Society of Addiction Medicine. ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol 2012; 119 (5) 1070-1076
- 11 Farrell M, Ward J, Mattick R , et al. Methadone maintenance treatment in opiate dependence: a review. BMJ 1994; 309 (6960) 997-1001
- 12 Kandall SR, Doberczak TM, Jantunen M, Stein J. The methadone-maintained pregnancy. Clin Perinatol 1999; 26 (1) 173-183
- 13 Hulse GK, Milne E, English DR, Holman CD. The relationship between maternal use of heroin and methadone and infant birth weight. Addiction 1997; 92 (11) 1571-1579
- 14 Hulse GK, Milne E, English DR, Holman CD. Assessing the relationship between maternal opiate use and neonatal mortality. Addiction 1998; 93 (7) 1033-1042
- 15 Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev 2009; (3) CD002209
- 16 Burns L, Mattick RP, Lim K, Wallace C. Methadone in pregnancy: treatment retention and neonatal outcomes. Addiction 2007; 102 (2) 264-270
- 17 Fajemirokun-Odudeyi O, Sinha C, Tutty S , et al. Pregnancy outcome in women who use opiates. Eur J Obstet Gynecol Reprod Biol 2006; 126 (2) 170-175
- 18 Kleber HD. Methadone maintenance 4 decades later: thousands of lives saved but still controversial. JAMA 2008; 300 (19) 2303-2305
- 19 Ballard JL, Dazmaier K, Driver M. A simplified assessment of gestational age. Pediatr Res 1977; 11: 372
- 20 Franck L, Vilardi J. Assessment and management of opioid withdrawal in ill neonates. Neonatal Netw 1995; 14 (2) 39-48
- 21 Finnegan LP, Kron RE, Connaughton JF, Emich JP. Assessment and treatment of abstinence in the infant of the drug-dependent mother. Int J Clin Pharmacol Biopharm 1975; 12 (1–2) 19-32
- 22 Chasnoff IJ, Hatcher R, Burns WJ. Polydrug- and methadone-addicted newborns: a continuum of impairment?. Pediatrics 1982; 70 (2) 210-213
- 23 Slowik MK, Jhaveri R. Hepatitis B and C viruses in infants and young children. Semin Pediatr Infect Dis 2005; 16 (4) 296-305
- 24 Bruneau J, Roy E, Arruda N, Zang G, Jutras-Aswad D. The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users. Addiction 2012; 107 (7) 1318-1327
- 25 Dryden C, Young D, Hepburn M, Mactier H. Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG 2009; 116 (5) 665-671
- 26 Smyth BP, Keenan E, O'Connor JJ. Bloodborne viral infection in Irish injecting drug users. Addiction 1998; 93 (11) 1649-1656
- 27 Kuschel CA, Austerberry L, Cornwell M, Couch R, Rowley RS. Can methadone concentrations predict the severity of withdrawal in infants at risk of neonatal abstinence syndrome?. Arch Dis Child Fetal Neonatal Ed 2004; 89 (5) F390-F393
- 28 Dashe JS, Sheffield JS, Olscher DA, Todd SJ, Jackson GLGD, Wendel GD. Relationship between maternal methadone dosage and neonatal withdrawal. Obstet Gynecol 2002; 100 (6) 1244-1249
- 29 Kayemba-Kay's S, Laclyde JP. Buprenorphine withdrawal syndrome in newborns: a report of 13 cases. Addiction 2003; 98 (11) 1599-1604
- 30 Mortimer PP, Vandervelde EM, Jesson WJ, Pereira MS, Burkhardt F. HTLV-III antibody in Swiss and English intravenous drug abusers. Lancet 1985; 2 (8452) 449-450
- 31 Conte GL, Mazzoni S, Serretti A, Fundarò C, Tempesta E. “Separation” of the mother-child couple: pregnancy and maternity of drug-dependent women. Acta Paediatr Suppl 1994; 404: 47-53
- 32 Farid WO, Dunlop SA, Tait RJ, Hulse GK. The effects of maternally administered methadone, buprenorphine and naltrexone on offspring: review of human and animal data. Curr Neuropharmacol 2008; 6 (2) 125-150
- 33 Cleary BJ, Donnelly JM, Strawbridge JD , et al. Methadone and perinatal outcomes: a retrospective cohort study. Am J Obstet Gynecol 2011; 204 (2) 139.e1-139.e9
- 34 Arlettaz R, Kashiwagi M, Das-Kundu S, Fauchère JC, Lang A, Bucher HU. Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources. Acta Obstet Gynecol Scand 2005; 84 (2) 145-150
- 35 Brown HL, Britton KA, Mahaffey D, Brizendine E, Hiett AK, Turnquest MA. Methadone maintenance in pregnancy: a reappraisal. Am J Obstet Gynecol 1998; 179 (2) 459-463
- 36 Kaltenbach K, Finnegan LP. Perinatal and developmental outcome of infants exposed to methadone in-utero. Neurotoxicol Teratol 1987; 9 (4) 311-313
- 37 Stanhope TJ, Gill LA, Rose C. Chronic opioid use during pregnancy: maternal and fetal implications. Clin Perinatol 2013; 40 (3) 337-350
- 38 Cleary BJ, Eogan M, O'Connell MP , et al. Methadone and perinatal outcomes: a prospective cohort study. Addiction 2012; 107 (8) 1482-1492
- 39 Sharpe C, Kuschel C. Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed 2004; 89 (1) F33-F36
- 40 Seligman NS, Almario CV, Hayes EJ, Dysart KC, Berghella V, Baxter JK. Relationship between maternal methadone dose at delivery and neonatal abstinence syndrome. J Pediatr 2010; 157 (3) 428-433 , 433.e1
- 41 Isemann B, Meinzen-Derr J, Akinbi H. Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol 2011; 31 (1) 25-29
- 42 Berghella V, Lim PJ, Hill MK, Cherpes J, Chennat J, Kaltenbach K. Maternal methadone dose and neonatal withdrawal. Am J Obstet Gynecol 2003; 189 (2) 312-317
- 43 Doberczak TM, Kandall SR, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr 1991; 118 (6) 933-937
- 44 Dysart K, Hsieh HC, Kaltenbach K, Greenspan JS. 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 (4) 344-346
- 45 Rosen TS, Pippenger CE. Pharmacologic observations on the neonatal withdrawal syndrome. J Pediatr 1976; 88 (6) 1044-1048
- 46 Mack G, Thomas D, Giles W, Buchanan N. Methadone levels and neonatal withdrawal. J Paediatr Child Health 1991; 27 (2) 96-100
- 47 Nekhayeva IA, Nanovskaya TN, Deshmukh SV, Zharikova OL, Hankins GD, Ahmed MS. Bidirectional transfer of methadone across human placenta. Biochem Pharmacol 2005; 69 (1) 187-197
- 48 Kuschel C. Managing drug withdrawal in the newborn infant. Semin Fetal Neonatal Med 2007; 12 (2) 127-133
- 49 Lainwala S, Brown ER, Weinschenk NP, Blackwell MT, Hagadorn JI. 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 (5) 265-272
- 50 Shaw NJ, McIvor L. Neonatal abstinence syndrome after maternal methadone treatment. Arch Dis Child Fetal Neonatal Ed 1994; 71 (3) F203-F205
- 51 Pizarro D, Habli M, Grier M, Bombrys A, Sibai B, Livingston J. Higher maternal doses of methadone does not increase neonatal abstinence syndrome. J Subst Abuse Treat 2011; 40 (3) 295-298
- 52 Jones HE, Kaltenbach K, Heil SH , et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med 2010; 363 (24) 2320-2331
- 53 Rosen TS, Pippenger CE. Disposition of methadone and its relationship to severity of withdrawal in the newborn. Addict Dis 1975; 2 (1–2) 169-178
- 54 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 (3) 253-258
- 55 Strauss ME, Andresko M, Stryker JC, Wardell JN. Relationship of neonatal withdrawal to maternal methadone dose. Am J Drug Alcohol Abuse 1976; 3 (2) 339-345
- 56 Madden JD, Chappel JN, Zuspan F, Gumpel J, Mejia A, Davis R. Observation and treatment of neonatal narcotic withdrawal. Am J Obstet Gynecol 1977; 127 (2) 199-201
- 57 Ebner N, Rohrmeister K, Winklbaur B , et al. Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Drug Alcohol Depend 2007; 87 (2–3) 131-138
- 58 Blandthorn J, Forster DA, Love V. Neonatal and maternal outcomes following maternal use of buprenorphine or methadone during pregnancy: findings of a retrospective audit. Women Birth 2011; 24 (1) 32-39
- 59 Lim S, Prasad MR, Samuels P, Gardner DK, Cordero L. High-dose methadone in pregnant women and its effect on duration of neonatal abstinence syndrome. Am J Obstet Gynecol 2009; 200 (1) 70.e1-70.e5
- 60 Wouldes TA, Woodward LJ. Maternal methadone dose during pregnancy and infant clinical outcome. Neurotoxicol Teratol 2010; 32 (3) 406-413
- 61 Harper RG, Solish G, Feingold E, Gersten-Woolf NB, Sokal MM. Maternal ingested methadone, body fluid methadone, and the neonatal withdrawal syndrome. Am J Obstet Gynecol 1977; 129 (4) 417-424
- 62 Malpas TJ, Darlow BA, Lennox R, Horwood LJ. Maternal methadone dosage and neonatal withdrawal. Aust N Z J Obstet Gynaecol 1995; 35 (2) 175-177
- 63 Ostrea EM, Chavez CJ, Strauss ME. A study of factors that influence the severity of neonatal narcotic withdrawal. J Pediatr 1976; 88 (4 Pt 1) 642-645
- 64 Blinick G, Jerez E, Wallach RC. Methadone maintenance, pregnancy, and progeny. JAMA 1973; 225 (5) 477-479
- 65 Newman RG, Bashkow S, Calko D. Results of 313 consecutive live births of infants delivered to patients in the New York City Methadone Maintenance Treatment Program. Am J Obstet Gynecol 1975; 121 (2) 233-237
- 66 McCarthy JJ, Leamon MH, Parr MS, Anania B. High-dose methadone maintenance in pregnancy: maternal and neonatal outcomes. Am J Obstet Gynecol 2005; 193 (3 Pt 1): 606-610
- 67 Bakstad B, Sarfi M, Welle-Strand GK, Ravndal E. Opioid maintenance treatment during pregnancy: occurrence and severity of neonatal abstinence syndrome. A national prospective study. Eur Addict Res 2009; 15 (3) 128-134
- 68 Cleary BJ, Donnelly J, Strawbridge J , et al. Methadone dose and neonatal abstinence syndrome-systematic review and meta-analysis. Addiction 2010; 105 (12) 2071-2084
- 69 Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA)13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013
- 70 Jansson LM, DiPietro JA, Elko A, Williams EI, Milio L, Velez M. Pregnancies exposed to methadone: A comparison of fetal neurobehaviors and infant outcomes. Drug Alcohol Depend 2012; 122: 213-219
- 71 Simmat-Durant L, Lejeune C. Polydrug use during pregnancy and neonatal outcome: Data from a ten-year retrospective French study. J Neo Nurs 2012; 18 (6) 232-240
- 72 Choo RE, Huestis MA, Schroeder JR, Shin AS, Jones HE. Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure. Drug Alcohol Depend 2004; 75 (3) 253-260
- 73 Seligman NS, Salva N, Hayes EJ, Dysart KC, Pequignot EC, Baxter JK. Predicting length of treatment for neonatal abstinence syndrome in methadone-exposed neonates. Am J Obstet Gynecol 2008; 199 (4) 396.e1-396.e7
- 74 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 (1–3) 200-206
- 75 ACOG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol 2008; 111 (4) 1001-1020
- 76 Sanz EJ, De-las-Cuevas C, Kiuru A, Bate A, Edwards R. Selective serotonin reuptake inhibitors in pregnant women and neonatal withdrawal syndrome: a database analysis. Lancet 2005; 365 (9458) 482-487
- 77 Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med 2006; 160 (2) 173-176
- 78 Mayes LC, Carroll KM. Neonatal withdrawal syndrome in infants exposed to cocaine and methadone. Subst Use Misuse 1996; 31 (2) 241-253
- 79 Bar-Oz B, Klein J, Karaskov T, Koren G. Comparison of meconium and neonatal hair analysis for detection of gestational exposure to drugs of abuse. Arch Dis Child Fetal Neonatal Ed 2003; 88 (2) F98-F100
- 80 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 (6) e1163-e1169
- 81 Malpas TJ, Darlow BA. Neonatal abstinence syndrome following abrupt cessation of breastfeeding. N Z Med J 1999; 112 (1080) 12-13
- 82 Wojnar-Horton RE, Kristensen JH, Yapp P, Ilett KF, Dusci LJ, Hackett LP. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol 1997; 44 (6) 543-547
- 83 Jansson LM, Choo R, Velez ML , et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 2008; 121 (1) 106-114
- 84 Kreek MJ. Methadone disposition during the perinatal period in humans. Pharmacol Biochem Behav 1979; 11 (Suppl): 7-13
- 85 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 (6) 681-685
- 86 American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108 (3) 776-789
- 87 Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics 2002; 109 (4) 590-593