Download PDF
Am J Perinatol 2020; 37(11): 1177-1182
DOI: 10.1055/s-0039-1692684
Original Article

Effects of Partially Hydrolyzed Formula on Severity and Outcomes of Neonatal Abstinence Syndrome

Mahdi Alsaleem
1   Division of Neonatal-Perinatal Medicine, The State University of New York at Buffalo, Buffalo, New York
,
Sara K. Berkelhamer
1   Division of Neonatal-Perinatal Medicine, The State University of New York at Buffalo, Buffalo, New York
,
Gregory E. Wilding
2   Department of Biostatistics, The State University of New York at Buffalo, Buffalo, New York
,
Lorin M. Miller
2   Department of Biostatistics, The State University of New York at Buffalo, Buffalo, New York
,
Anne Marie Reynolds
1   Division of Neonatal-Perinatal Medicine, The State University of New York at Buffalo, Buffalo, New York
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study compares the effect of partially hydrolyzed formula (PHF) and standard formula (SF) on the severity and short-term outcomes of neonatal abstinence syndrome (NAS).

Study Design We performed a retrospective chart review of 124 opioid-dependent mothers and their term or near-term infants. Infants were categorized according to the predominant type of formula consumed during the hospital stay. Finnegan's scale was used to assess symptoms of withdrawal.

Results A total of 110 infants met our inclusion criteria. Thirty-four (31%) infants were fed predominantly PHF, 60 (54%) infants were fed SF, and 16 (15%) infants were fed maternal breast milk. There was no difference between the infants in the PHF and SF groups with respect to requirement of morphine (MSO4) therapy, maximum dose of MSO4 used, duration of MSO4 treatment or length of hospital stay after performing multivariate analyses to control for type of drug used by the mother, maternal smoking, regular prenatal care, inborn status, and maximum Finnegan score prior to MSO4 treatment.

Conclusion Use of PHF failed to impact short-term outcomes in infants treated for NAS including maximum MSO4 dose, duration of MSO4 treatment, and length of hospital stay. A prospective randomized controlled trial may be indicated to confirm this finding.

Keywords

neonatal abstinence - infant formula - drug withdrawal - hydrolyzed formula

Note

Statistical analysis reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number UL1TR001412.




Publication History

Received: 14 April 2019

Accepted: 09 May 2019

Article published online:
25 June 2019

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Kocherlakota P. Neonatal abstinence syndrome. Pediatrics 2014; 134 (02) e547-e561
    CrossrefPubMedSearch in Google Scholar
  • 2 Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012; 307 (18) 1934-1940
    CrossrefPubMedSearch in Google Scholar
  • 3 Wright TE. Opioid-Use Disorders in Pregnancy: Management Guidelines for Improving Outcomes. Cambridge, UK: Cambridge University Press; 2018
    CrossrefSearch in Google Scholar
  • 4 Finnegan LP, Connaughton Jr JF, Kron RE, Emich JP. Neonatal abstinence syndrome: assessment and management. Addict Dis 1975; 2 (1-2): 141-158
    PubMedSearch in Google Scholar
  • 5 McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med 2016; 375 (25) 2468-2479
    CrossrefPubMedSearch in Google Scholar
  • 6 Stover MW, Davis JM. Opioids in pregnancy and neonatal abstinence syndrome. Paper presented at Seminars in Perinatology; 2015
    PubMedSearch in Google Scholar
  • 7 Hudak ML, Tan RC. Neonatal drug withdrawal. Pediatrics 2012; 129 (02) e540-e560
    CrossrefPubMedSearch in Google Scholar
  • 8 Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol 2015; 35 (08) 650-655
    CrossrefPubMedSearch in Google Scholar
  • 9 Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstet Gynecol 2011; 204 (03) 259.e1-259.e4
    CrossrefPubMedSearch in Google Scholar
  • 10 Haas A. Identification of neonatal abstinence syndrome in the community: infants born into Canada's opioid crisis. Paediatr Child Health 2019; 24 (02) 81-84
    CrossrefPubMedSearch in Google Scholar
  • 11 Maguire D, Gröer M. Neonatal abstinence syndrome and the gastrointestinal tract. Med Hypotheses 2016; 97: 11-15
    CrossrefPubMedSearch in Google Scholar
  • 12 Abdel-Latif ME, Pinner J, Clews S, Cooke F, Lui K, Oei J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006; 117 (06) e1163-e1169
    CrossrefPubMedSearch in Google Scholar
  • 13 Malpas T, Darlow B, Horwood J. Breastfeeding reduces the severity of neonatal abstinence syndrome. J Paediatr Child Health 1997; 33 (04) A38
    CrossrefPubMedSearch in Google Scholar
  • 14 O'Connor AB, Collett A, Alto WA, O'Brien LM. Breastfeeding rates and the relationship between breastfeeding and neonatal abstinence syndrome in women maintained on buprenorphine during pregnancy. J Midwifery Womens Health 2013; 58 (04) 383-388
    CrossrefPubMedSearch in Google Scholar
  • 15 Liu A, Juarez J, Nair A, Nanan R. Feeding modalities and the onset of the neonatal abstinence syndrome. Front Pediatr 2015; 3: 14
    PubMedSearch in Google Scholar
  • 16 Walsh MC, Crowley M, Wexelblatt S. , et al; Ohio Perinatal Quality Collaborative. Ohio perinatal quality collaborative improves care of neonatal narcotic abstinence syndrome. Pediatrics 2018; 141 (04) e20170900
    CrossrefPubMedSearch in Google Scholar
  • 17 Bogen DL, Whalen BL, Kair LR, Vining M, King BA. Wide variation found in care of opioid-exposed newborns. Acad Pediatr 2017; 17 (04) 374-380
    CrossrefPubMedSearch in Google Scholar
  • 18 Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am 2013; 60 (01) 49-74
    CrossrefPubMedSearch in Google Scholar
  • 19 Belamarich PF, Bochner RE, Racine AD. A critical review of the marketing claims of infant formula products in the United States. Clin Pediatr (Phila) 2016; 55 (05) 437-442
    CrossrefPubMedSearch in Google Scholar
  • 20 Liu AJ, Jones MP, Murray H, Cook CM, Nanan R. Perinatal risk factors for the neonatal abstinence syndrome in infants born to women on methadone maintenance therapy. Aust N Z J Obstet Gynaecol 2010; 50 (03) 253-258
    CrossrefPubMedSearch in Google Scholar
  • 21 Doberczak TM, Kandall SR, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr 1991; 118 (06) 933-937
    CrossrefPubMedSearch in Google Scholar
  • 22 Maguire D, Cline GJ, Parnell L, Tai C-Y. Validation of the Finnegan neonatal abstinence syndrome tool-short form. Adv Neonatal Care 2013; 13 (06) 430-437
    CrossrefPubMedSearch in Google Scholar
  • 23 Francavilla R, Calasso M, Calace L. , et al. Effect of lactose on gut microbiota and metabolome of infants with cow's milk allergy. Pediatr Allergy Immunol 2012; 23 (05) 420-427
    CrossrefPubMedSearch in Google Scholar
  • 24 Cederlund A, Kai-Larsen Y, Printz G. , et al. Lactose in human breast milk an inducer of innate immunity with implications for a role in intestinal homeostasis. PLoS One 2013; 8 (01) e53876
    CrossrefPubMedSearch in Google Scholar
  • 25 Abrams SA, Griffin IJ, Davila PM. Calcium and zinc absorption from lactose-containing and lactose-free infant formulas. Am J Clin Nutr 2002; 76 (02) 442-446
    CrossrefPubMedSearch in Google Scholar
  • 26 Lee Y-H. Food-processing approaches to altering allergenic potential of milk-based formula. J Pediatr 1992; 121 (5 Pt 2): S47-S50
    CrossrefPubMedSearch in Google Scholar
  • 27 Kinouchi T, Koyama S, Harada E, Yajima T. Large molecule protein feeding during the suckling period is required for the development of pancreatic digestive functions in rats. Am J Physiol Regul Integr Comp Physiol 2012; 303 (12) R1268-R1276
    CrossrefPubMedSearch in Google Scholar
  • 28 Vandenplas Y, Alarcon P, Fleischer D. , et al. Should partial hydrolysates be used as starter infant formula? A working group consensus. J Pediatr Gastroenterol Nutr 2016; 62 (01) 22-35
    CrossrefPubMedSearch in Google Scholar
  • 29 Holzer P. Pharmacology of opioids and their effects on gastrointestinal function. Am J Gastroenterol Suppl 2014; 2 (01) 9
    CrossrefPubMedSearch in Google Scholar
  • 30 Miraglia Del Giudice M, D'Auria E, Peroni D. , et al. Flavor, relative palatability and components of cow's milk hydrolysed formulas and amino acid-based formula. Ital J Pediatr 2015; 41 (01) 42
    CrossrefPubMedSearch in Google Scholar
  • 31 Armentrout DC, Caple J. The jittery newborn. J Pediatr Health Care 2001; 15 (03) 147-149
    CrossrefPubMedSearch in Google Scholar
  • 32 Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics 2002; 109 (04) 590-593
    CrossrefPubMedSearch in Google Scholar
  • 33 Begg EJ, Malpas TJ, Hackett LP, Ilett KF. Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing. Br J Clin Pharmacol 2001; 52 (06) 681-685
    CrossrefPubMedSearch in Google Scholar
  • 34 Kauffman RE, Banner W, Berlin C. , et al. American Academy of Pediatrics Committee on Drugs: the transfer of drugs and other chemicals into human milk. Pediatrics 1994; 93 (01) 137-150
    CrossrefPubMedSearch in Google Scholar
  • 35 Lindemalm S, Nydert P, Svensson J-O, Stahle L, Sarman I. Transfer of buprenorphine into breast milk and calculation of infant drug dose. J Hum Lact 2009; 25 (02) 199-205
    CrossrefPubMedSearch in Google Scholar
  • 36 Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med 2012; 7 (04) 269-274
    CrossrefPubMedSearch in Google Scholar