pediatrics
Prenatal Drug Exposure
Opioids
Opioid exposure in utero can cause withdrawal on delivery. The neonate of a woman who used Opioid Use Disorder and Rehabilitation chronically during pregnancy should be observed for withdrawal symptoms (narcotic abstinence syndrome [NAS]). NAS usually occurs within 72 hours after delivery, although many neonatal units observe infants for 4 or 5 days to be sure there are no significant signs of withdrawal. Characteristic signs of withdrawal include Irritability Jitteriness Hypertonicity Vomiting and/or diarrhea Sweating Seizures Hyperventilation that causes respiratory alkalosis Prenatal benzodiazepine exposure may cause similar effects. There are many scoring systems to help quantify the severity of withdrawal (seeThe Opioid Exposed Newborn: Assessment and Pharmacologic Management). Mild withdrawal symptoms are treated by a few days of swaddling and soothing care to alleviate the physical overarousal and by giving frequent feedings to reduce restlessness. With patience, some problems resolve in no more than a week. The Eat, Sleep, Console (ESC) approach for NAS assessment ( Opioids references , , or sometimes tincture of opium. Dosing is based on the weight of the infant and the severity of the symptoms. Typically, a starting dose is given and increased until symptoms are controlled and then slowly tapered ( see Table: One Drug Regimen for Neonatal Opioid Withdrawal ). Drug Starting Dose Incremental Increase Taper Morphine 0.04 mg/kg orally every 3–4 hours 0.04 mg/kg/dose 10–20% every 2–3 days Methadone 0.05–0.1 mg/kg orally every 6 hours 0.05 mg/kg/dose 10–20% every week Adapted fromHudak ML, Tan RC, The Committee on Drugs, The Committee on Fetus and Newborn: Neonatal drug withdrawal.Pediatrics129:E540–E560, 2012. doi: 10.1542/peds.2011-3212 The addition ofclonidine1 mcg/kg orally every 4 hours may reduce the duration of drug treatment needed in full-term infants. However,clonidineshould not be given to premature infants because of the risk of bradycardia. Ifclonidineis used, blood pressure should be monitored as theclonidinedose is tapered because there can be rebound hypertension. The incidence of Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS) is greater among infants born to women addicted to opioids but still is 