Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Neonatal Abstinence Syndrome Workup

  • Author: Ashraf H Hamdan, MD, MBBCh, MSc, MRCP; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Jan 02, 2016
 

Laboratory Studies

Health care professionals, hospitals, and clinics have an obligation to assess newborns who exhibit signs and symptoms of drug exposure, whose mothers have been identified as probable substance users, or whose mothers have signs and symptoms of drug use.

Clear evidence suggests that recognizing the substance exposed infant and implementing early intervention services for the child and mother are keys to minimizing the acute and long-term effects of prenatal substance exposure. Thus, even if the infant exhibits no clinically significant difficulties in the neonatal period, identification of the substance exposed infant can improve the long-term outcome.

Specific clinical conditions for which urine or meconium toxicology testing is indicated are noted. Commonly accepted indications for toxicology analysis include no prenatal care, intrauterine growth retardation (IUGR), preterm delivery, abruptio placentae, or cardiovascular accidents in mother or child, especially in those cases in which no other reasons for poor outcome are noted.[38]

The studies discussed below may be necessary to prevent or diagnose cases of neonatal abstinence syndrome (NAS).

Radioimmunoassay and enzyme immunoassay

These are the most commonly used drug screens. Both are semiquantitative and highly sensitive, but enzyme immunoassay takes less time to perform and is less expensive.

These tests inform the clinician about the presence or absence of substance abuse, rather than quantifying the drug level, as in toxicology screens.

Blood tests

The usefulness of neonatal blood samples varies. Blood samples are of limited value because the window of detection is narrow because of the rapid effects of metabolism and the low concentrations of drugs present in blood.

Urine toxicology assays

Note the following:

  • Urine was traditionally the specimen of choice for neonatal drug testing, although collection is difficult. The adhesive for the collection bag causes skin irritation and frequently fails to adhere. Another disadvantage is the short detection window; urine provides maternal drug use data only for a few days prior to delivery.
  • Urine toxicology screening is useful for clinical and research purposes. Urinary excretion of metabolites may be detectable only for a few days (eg, benzoylecgonine) to a few weeks (eg, cannabinoids). One cannot expect to ascertain early pregnancy use or even relatively recent use if the metabolite concentration does not reach the detection threshold.
  • Urine is relatively easy to obtain, requires minimal preparation (provided samples are not contaminated by meconium or feces), and can be analyzed using numerous laboratory techniques. Although urine samples generally contain a higher drug concentration than serum samples, the detection of compounds depends on obtaining an appropriate sample as close as possible to birth and also depends on the timing of maternal drug ingestion prior to delivery.
  • These tests detect recent use of cocaine and its metabolites, amphetamines, marijuana, barbiturates, and opiates. Cocaine can be detected in urine 6-8 hours after use in the mother and as long as 48-72 hours after use in the newborn. Alcohol is detectable in neonatal urine for 6-16 hours after the last maternal ingestion.
  • Detection of drugs depends on many variables, including individual drug metabolism, hydration status of the subject, route of administration, and frequency of ingestion.
  • No drugs are known to crossreact with the immunoassays for cocaine and marijuana. Several over-the-counter remedies and herbal preparations may contain ephedrine and phenylpropanolamine (recalled from US market), which can produce false-positive enzyme immunoassay test results for amphetamines. Therefore, confirmatory testing is required.
  • Immunoassay for opiates does not distinguish between codeine, morphine, or their glucuronide conjugates.

Meconium analysis

Note the following:

  • Meconium analysis is currently considered the best method for detecting drug exposure in pregnancy. It provides a wider window of detection of gestational exposure, presumably as remote as the second trimester, when drugs begin to accumulate in meconium (by direct deposition from the biliary tree or when the fetus ingests amniotic fluid).
  • Meconium analysis is reliable for detecting opioid and cocaine exposure after the first trimester and can be used to detect a range of other illicit and prescribed medications.
  • Meconium can be contaminated by infant urine, although only cocaine or opiate use within approximately 72 hours of birth is reflected.
  • False positive results occur if meconium is contaminated with urine, reflecting antepartum and perinatal exposure. Theoretically, lidocaine can cause a positive result, but a large amount is required.
  • When a meconium sample is stored at room temperature, it decreases cocaine and cannabinoid levels by 25% per day.

Hair analysis

Neonatal hair testing can also identify prenatal drug exposure. Hair begins to form at approximately 6 months' gestation; a positive result indicates use during the last trimester. Hair testing is advantageous because the specimen can be collected at any point during the first 3 months of life, after which time infant hair replaces neonatal hair.[39]

This method is useful in detecting narcotics, marijuana, cocaine, and cocaine-alcohol metabolites, but the technique is expensive, is not widely available, and is limited by the procedures required to quantify the very small amounts of drug present. Obtaining an adequate sample may be difficult, and recent exposure might not be detected because hair growth is slow.

Analysis of 1.5 cm of maternal hair reveals the maternal drug use pattern during the previous 3 months. Drug metabolites can be detected in infant hair for 2-3 months after birth.

Next

Imaging Studies

Cranial ultrasonography is not routinely recommended, but literature is suggestive of CNS abnormalities, including hemorrhagic ischemic lesions in some drug-exposed infants.

Evidence is insufficient to support a mandate for cranial ultrasonography in all cocaine-exposed infants. Smit et al studied 154 neonates exposed to cocaine in utero and found that none of the infants had severe abnormalities on cranial ultrasonography. Also, the detected abnormalities were not correlated with the duration or maximum amount of cocaine use. Given these findings, they recommended that routine cranial ultrasonography in this population is not warranted.[40] However, special consideration should be given to specific neuroimaging of cocaine-exposed preterm infants, infants whose head circumference falls below the 10th percentile on standardized fetal growth curves, and infants with abnormal neurologic signs, neurobehavioral dysfunction, or seizure activity.

Previous
Next

Other Tests

A recent report has suggested that detecting drug exposure from umbilical cord tissue has similar sensitivity and specificity to meconium samples and may have some advantages over collection of meconium.[41] Testing umbilical cord tissue enables analysis to occur immediately after birth, compared with meconium testing, which is delayed as long as 3 days prior to specimen availability. Umbilical cord is easily and noninvasively collected and may reflect a long window of drug detection; however, because few studies have examined cord tissue analysis to date, interpreting results is difficult.

Drug-exposed infants are at increased risk of acquiring infections transmitted from mothers whose lifestyles include unsafe sexual practices or intravenous drug abuse. Assessment of the mother who abuse drugs and their infants for hepatitis B and hepatitis C and sexually transmitted diseases including human immunodeficiency virus (HIV) should be incorporated into the prenatal care setting and delivery hospitalization.

Previous
 
 
Contributor Information and Disclosures
Author

Ashraf H Hamdan, MD, MBBCh, MSc, MRCP Clinical Associate Professor of Pediatrics, Vanderbilt University Medical Center; Neonatologist, Pediatrix Medical Group of Nashville

Ashraf H Hamdan, MD, MBBCh, MSc, MRCP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Scott S MacGilvray, MD Clinical Professor, Department of Pediatrics, Division of Neonatology, The Brody School of Medicine at East Carolina University

Scott S MacGilvray, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases, gratefully acknowledge the contributions of previous authors Jaques Belik, MD, and Judy Hawes, RN, MN, to the writing and development of this article.

References
  1. Stover MW, Davis JM. Opioids in pregnancy and neonatal abstinence syndrome. Semin Perinatol. 2015 Nov. 39 (7):561-5. [Medline].

  2. Chana S, Anand K. Can we use methadone for Analgesia in neonates?. Arch Dis Child Fetal Neonatal Ed. 2001. 85:79-81. [Medline]. [Full Text].

  3. Franck LS, Vilardi J, Durand D, Powers R. Opioid withdrawal in neonates after continuous infusions of morphine or fentanyl during extracorporeal membrane oxygenation. Am J Crit Care. 1998 Sep. 7(5):364-9. [Medline].

  4. Substance Abuse and Mental Health Services Administration Office of Applied Studies. 2003 National Survey on Drug Use & Health: Results. US Department of Health and Human Services. Available at http://www.drugabusestatistics.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm. Accessed: December, 2007.

  5. 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 May 9. 307(18):1934-40. [Medline].

  6. Hytinantti T, Kahila H, Renlund M, Jarvenpaa AL, Halmesmaki E, Kivitie-Kallio S. Neonatal outcome of 58 infants exposed to maternal buprenorphine in utero. Acta Paediatr. 2008 Aug. 97(8):1040-4. [Medline].

  7. 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 Jan. 200(1):70.e1-5. [Medline].

  8. 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 Apr. 116(5):665-71. [Medline].

  9. Wouldes TA, Woodward LJ. Maternal methadone dose during pregnancy and infant clinical outcome. Neurotoxicol Teratol. 2010 May-Jun. 32(3):406-13. [Medline].

  10. BJ Cleary, M Eogan, MP O’Connell, T Fahey, PJ Gallagher, T Clarke, et al. Methadone and Perinatal Outcomes – a Prospective Cohort Study. Addiction. [Medline].

  11. Minozzi S, Amato L, Bellisario C, Ferri M, Davoli M. Maintenance agonist treatments for opiate-dependent pregnant women. Cochrane Database Syst Rev. 2013. 12:CD006318. [Medline].

  12. Buprenorphine treatment in pregnancy: less distress to babies. December 9, 2010. Available at http://www.nih.gov/news/health/dec2010/nida-09.htm.

  13. Jones HE, Dengler E, Garrison A, O'Grady KE, Seashore C, Horton E. Neonatal outcomes and their relationship to maternal buprenorphine dose during pregnancy. Drug Alcohol Depend. 2014 Jan 1. 134:414-7. [Medline].

  14. Kandall SR. Treatment strategies for drug-exposed neonates. Clin Perinatol. 1999 Mar. 26(1):231-43. [Medline].

  15. Law KL, Stroud LR, LaGasse LL, et al. Smoking during pregnancy and newborn neurobehavior. Pediatrics. 2003 Jun. 111(6 Pt 1):1318-23. [Medline]. [Full Text].

  16. Haddad PM, Pal BR, Clarke P, Wieck A, Sridhiran S. Neonatal symptoms following maternal paroxetine treatment: serotonin toxicity or paroxetine discontinuation syndrome?. J Psychopharmacol. 2005 Sep. 19(5):554-7. [Medline].

  17. Bence C, Bonord A, Rebillard C, et al. Neonatal abstinence syndrome following tianeptine dependence during pregnancy. Pediatrics. 2015 Dec 11. [Medline].

  18. Anand KJ, Campbell-Yeo M. Consequences of prenatal opioid use for newborns. Acta Paediatr. 2015 Nov. 104 (11):1066-9. [Medline].

  19. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. US Department of Health and Human Services. September 2013. Available at http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm#ch2.6.

  20. Trends in Substances of Abuse among Pregnant Women and Women of Childbearing Age in Treatment. July 2013. Available at http://www.samhsa.gov/data/spotlight/spot110-trends-pregnant-women-2013.pdf.

  21. SAMHSA. Substance Use among Women During Pregnancy and Following Childbirth. Substance Abuse and Mental Health Services Administration. May 21, 2009. Available at http://www.oas.samhsa.gov/2k9/135/PregWoSubUse.htm.

  22. Cairns PA. Drug misuse: Conception into childhood. Current Paediatrics. 2001 December. 11(6):475-9.

  23. Prentice S. Substance misuse in pregnancy. Obstetrics, Gynaecology & Reproductive Med. 2007 September. 17:272-7.

  24. Gyarmathy VA, Giraudon I, Hedrich D, Montanari L, Guarita B, Wiessing L. Drug use and pregnancy - challenges for public health. Euro Surveill. 2009 Mar 5. 14(9):33-6. [Medline]. [Full Text].

  25. Licit and Illicit Drug Use during Pregnancy: Maternal, Neonatal and Early Childhood Consequences. 2013. Available at http://www.ccsa.ca/2013%20CCSA%20Documents/CCSA-Drug-Use-during-Pregnancy-Summary-2013-en.pdf.

  26. Substance Use During Pregnancy: 2002 and 2003 Update. National survey on drug use and health. June 2, 2005. Available at http://www.oas.samhsa.gov/2k5/pregnancy/pregnancy.htm.

  27. Lester BM, ElSohly M, Wright LL, Smeriglio VL, Verter J, Bauer CR. The Maternal Lifestyle Study: drug use by meconium toxicology and maternal self-report. Pediatrics. 2001 Feb. 107(2):309-17. [Medline].

  28. [Guideline] American Academy of Pediatrics Committee on Substance Abuse. Drug-exposed infants. Pediatr. 1995 Aug. 96(2 Pt 1):364-7. [Medline].

  29. Doberczak TM, Kandall SR, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr. 1991 Jun. 118(6):933-7. [Medline].

  30. 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 Jun. 50(3):253-8. [Medline].

  31. [Guideline] Hudak ML, Tan RC. Neonatal Drug Withdrawal. Pediatrics. January 2012. 129(2):e540-560. [Full Text].

  32. Finnegan LP. Neonatal abstinence syndrome: assessment and pharmacolotherapy. Neonatal therapy: An update. New York, NY: Excerpta Medica; 1986. 122-46.

  33. Ostrea EM, Ostrea AR, Simpson PM. Mortality within the first 2 years in infants exposed to cocaine, opiate, or cannabinoid during gestation. Pediatrics. 1997 Jul. 100(1):79-83. [Medline]. [Full Text].

  34. Lester BM, Tronick EZ. History and description of the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Pediatrics. 2004 Mar. 113(3 Pt 2):634-40. [Medline].

  35. Maternal Resource Center. Prenatal Substance Exposure. April 2008. [Full Text].

  36. Jaudes PK, Ekwo E, Van Voorhis J. Association of drug abuse and child abuse. Child Abuse Negl. 1995 Sep. 19(9):1065-75. [Medline].

  37. Smith DK, Johnson AB, Pears KC, Fisher PA, DeGarmo DS. Child maltreatment and foster care: unpacking the effects of prenatal and postnatal parental substance use. Child Maltreat. 2007 May. 12(2):150-60. [Medline].

  38. Chasnoff IJ. Prenatal substance exposure: maternal screening and neonatal identification and management. Neoreviews. 2003. 4(9):e228-e235.

  39. Gray T, Huestis M. Bioanalytical procedures for monitoring in utero drug exposure. Anal Bioanal Chem. 2007 Aug. 388(7):1455-65. [Medline].

  40. van Huis M, van Kempen AA, Peelen M, Timmers M, Boer K, Smit BJ. Brain ultrasonography findings in neonates with exposure to cocaine during pregnancy. Pediatr Radiol. 2009 Mar. 39(3):232-8. [Medline].

  41. Kassima Z, Greenough A. Neonatal abstinence syndrome: Identification and management. Current Paediatrics. 2006 June. 16:172-5.

  42. 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 Oct. 5(5):265-72. [Medline].

  43. Kraft WK, Gibson E, Dysart K, et al. Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial. Pediatrics. 2008 Sep. 122(3):e601-7. [Medline]. [Full Text].

  44. Young ME, Hager SJ, Spurlock D Jr. Retrospective chart review comparing morphine and methadone in neonates treated for neonatal abstinence syndrome. Am J Health Syst Pharm. 2015 Dec 1. 72 (23 suppl 3):S162-7. [Medline].

  45. Hall ES, Isemann BT, Wexelblatt SL, et al. A cohort comparison of buprenorphine versus methadone treatment for neonatal abstinence syndrome. J Pediatr. 2015 Dec 15. [Medline].

  46. Hall ES, Wexelblatt SL, Crowley M, Grow JL, Jasin LR, Klebanoff MA, et al. A multicenter cohort study of treatments and hospital outcomes in neonatal abstinence syndrome. Pediatrics. 2014 Aug. 134(2):e527-34. [Medline].

  47. Pullen L. Neonatal Abstinence Syndrome: Stringent Weaning Protocol Best. Available at http://www.medscape.com/viewarticle/829115. Accessed: August 4, 2014.

  48. Saiki T, Lee S, Hannam S, Greenough A. Neonatal abstinence syndrome--postnatal ward versus neonatal unit management. Eur J Pediatr. 2010 Jan. 169(1):95-8. [Medline].

  49. Backes CH, Backes CR, Gardner D, Nankervis CA, Giannone PJ, Cordero L. Neonatal abstinence syndrome: transitioning methadone-treated infants from an inpatient to an outpatient setting. J Perinatol. 2012 Jun. 32(6):425-30. [Medline].

  50. Committee on Health Care for Underserved Women and the American Society of Addiction Medicine. Opioid Abuse, Dependence, and Addiction in Pregnancy. 2012 May. 524:[Full Text].

  51. Jansson LM. ABM clinical protocol #21: Guidelines for breastfeeding and the drug-dependent woman. Breastfeed Med. 2009 Dec. 4(4):225-8. [Medline]. [Full Text].

  52. Grim K, Harrison TE, Wilder RT. Management of neonatal abstinence syndrome from opioids. Clin Perinatol. 2013 Sep. 40(3):509-24. [Medline].

  53. Agthe AG, Kim GR, Mathias KB, et al. Clonidine as an adjunct therapy to opioids for neonatal abstinence syndrome: a randomized, controlled trial. Pediatrics. 2009 May. 123(5):e849-56. [Medline]. [Full Text].

  54. Sarkar S, Donn SM. Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey. J Perinatol. 2006 Jan 1. 26(1):15-7. [Medline].

  55. [Guideline] American Academy of Pediatrics Committee on Drugs. Neonatal drug withdrawal. [published erratum appears in Pediatrics 1998 Sep;102(3 Pt 1):660]. Pediatrics. 1998 Jun. 101(6):1079-88. [Medline].

  56. Mazurier E, Cambonie G, Barbotte E, Grare A, Pinzani V, Picaud JC. Comparison of chlorpromazine versus morphine hydrochloride for treatment of neonatal abstinence syndrome. Acta Paediatr. 2008 Oct. 97(10):1358-61. [Medline].

  57. SAMHSA. The Drug Addiction Treatment Act of 2000 (DATA 2000). DHHS. 2000. Available at http://buprenorphine.samhsa.gov/.

  58. Kraft WK, Gibson E, Dysart K, Damle VS, Larusso JL, Greenspan JS. Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial. Pediatrics. 2008 Sep. 122(3):e601-7. [Medline]. [Full Text].

  59. [Guideline] Jansson LM, Choo R, Velez ML, Harrow C, Schroeder JR, Shakleya DM. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics. 2008 Jan. 121(1):106-14. [Medline].

  60. [Guideline] AAP. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep. 108(3):776-89. [Medline].

  61. Anthony BE, Bryan BL. Neonatal Abstinence Syndrome. NeoReviews. 2009. 10(5):e222.

  62. Hale TW. Pharmacology review: drug therapy and breastfeeding: antidepressants, antipsychotics, antimanics, and sedatives. NeoReviews. May 2004. e451 -e456.

  63. Irner TB, Teasdale TW, Nielsen T, Vedal S, Olofsson M. Substance use during pregnancy and postnatal outcomes. J Addict Dis. 2012 Jan. 31(1):19-28. [Medline].

  64. Gray KA, Day NL, Leech S, Richardson GA. Prenatal marijuana exposure: effect on child depressive symptoms at ten years of age. Neurotoxicol Teratol. 2005 May-Jun. 27(3):439-48. [Medline].

  65. Goldschmidt L, Day NL, Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 2000 May-Jun. 22(3):325-36. [Medline].

  66. American Academy of Pediatrics. Pickering LK. The Red Book: 2006 Report of the Committee on Infectious Diseases. 27th. 2006.

  67. [Guideline] American Academy of Pediatrics Committee on Fetus and Newborn. The initiation or withdrawal of treatment for high-risk newborns. Pediatrics. 1995 Aug. 96(2 Pt 1):362-3. [Medline].

  68. Bahwere P, Haumont D, Delange F. Congenital hypothyroidism and neonatal withdrawal syndrome. Eur J Pediatr. 1996 Nov. 155(11):937-8. [Medline].

  69. Bauer CR. Perinatal effects of prenatal drug exposure. Neonatal aspects. Clin Perinatol. 1999 Mar. 26(1):87-106. [Medline].

  70. Boukydis CF, Lester BM. The NICU Network Neurobehavioral Scale. Clinical use with drug exposed infants and their mothers. Clin Perinatol. 1999 Mar. 26(1):213-30. [Medline].

  71. Buchi KF. The drug-exposed infant in the well-baby nursery. Clin Perinatol. 1998 Jun. 25(2):335-50. [Medline].

  72. Chasnoff IJ, Bussey ME, Savich R, Stack CM. Perinatal cerebral infarction and maternal cocaine use. J Pediatr. 1986 Mar. 108(3):456-9. [Medline].

  73. Connolly WB Jr, Marshall AB. Drug addiction, pregnancy, and childbirth: legal issues for the medical and social services communities. Clin Perinatol. 1991 Mar. 18(1):147-86. [Medline].

  74. Frank L. Assessment and management of opioid withdrawal in ill neonates. Neonatal Network. March. 14:39-48. [Medline].

  75. Heier LA, Carpanzano CR, Mast J, Brill PW, Winchester P, Deck MD. Maternal cocaine abuse: the spectrum of radiologic abnormalities in the neonatal CNS. AJNR Am J Neuroradiol. 1991 Sep-Oct. 12(5):951-6. [Medline].

  76. Johnson K, Gerada C, Greenough A. Treatment of neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed. 2003 Jan. 88(1):F2-5. [Medline].

  77. Jones HE, Heil SH, Baewert A, Arria AM, Kaltenbach K, Martin PR. Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review. Addiction. 2012 Nov. 107 Suppl 1:5-27. [Medline].

  78. Kallen B. Neonate characteristics after maternal use of antidepressants in late pregnancy. Arch Pediatr Adolesc Med. 2004 Apr. 158(4):312-6. [Medline]. [Full Text].

  79. Kaltenbach K, Berghella V, Finnegan L. Opioid dependence during pregnancy. Effects and management. Obstet Gynecol Clin North Am. 1998 Mar. 25(1):139-51. [Medline].

  80. Kandall RS. Improving Treatment for Drug-Exposed Infants Treatment Improvement Protocol (TIP) Series 5. Available at http://ncadi.samhsa.gov/govpubs/bkd110/default.aspx. Accessed: February, 14 2010.

  81. Kuschel C. Managing drug withdrawal in the newborn infant. Semin Fetal Neonatal Med. 2007 Apr. 12(2):127-33. [Medline].

  82. McKim EM. Caffeine and its effects on pregnancy and the neonate. J Nurse Midwifery. 1991 Jul-Aug. 36(4):226-31. [Medline].

  83. Moses-Kolko EL, Bogen D, Perel J, Bregar A, Uhl K, Levin B. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. JAMA. 2005 May 18. 293(19):2372-83. [Medline].

  84. Oei J, Lui K. Management of the newborn infant affected by maternal opiates and other drugs of dependency. J Paediatr Child Health. 2007 Jan-Feb. 43(1-2):9-18. [Medline].

  85. Pierog S, Chandavasu O, Wexler I. Withdrawal symptoms in infants with the fetal alcohol syndrome. J Pediatr. 1977 Apr. 90(4):630-3. [Medline].

  86. Pritham UA. Breastfeeding promotion for management of neonatal abstinence syndrome. J Obstet Gynecol Neonatal Nurs. 2013 Sep-Oct. 42(5):517-26. [Medline].

  87. SAMHSA. Special issues during pregnancy. DHHS. May 21, 2009. Available at http://www.ncsacw.samhsa.gov/files/Special_Issues_Pregnancy_Factsheets.pdf.

  88. Sanz EJ, De-las-Cuevas C, Kiuru A, et al. Selective serotonin reuptake inhibitors in pregnant women and neonatal withdrawal syndrome: a database analysis. Lancet. 2005 Feb 5-11. 365(9458):482-7. [Medline].

  89. Ter Horst PG, Jansman FG, van Lingen RA, Smit JP, de Jong-van den Berg LT, Brouwers JR. Pharmacological aspects of neonatal antidepressant withdrawal. Obstet Gynecol Surv. 2008 Apr. 63(4):267-79. [Medline].

  90. Theis JG, Selby P, Ikizler Y, Koren G. Current management of the neonatal abstinence syndrome: a critical analysis of the evidence. Biol Neonate. 1997. 71(6):345-56. [Medline].

  91. Umans JG, Szeto HH. Precipitated opiate abstinence in utero. Am J Obstet Gynecol. 1985 Feb 15. 151(4):441-4. [Medline].

  92. Vance JC, Chant DC, Tudehope DI, et al. Infants born to narcotic dependent mothers: physical growth patterns in the first 12 months of life. J Paediatr Child Health. 1997 Dec. 33(6):504-8. [Medline].

  93. Wagner CL, Katikaneni LD, Cox TH, Ryan RM. The impact of prenatal drug exposure on the neonate. Obstet Gynecol Clin North Am. 1998 Mar. 25(1):169-94. [Medline].

  94. Young T E, Mangum B. CNS Drugs. Thomson Reuters clinical editorial staff. Neofax: A manual of drugs used in neonatal care. 22nd ed. Montvale, New Jersey: Thomson Reuters healthcare; 2009. 187-214.

  95. Zeskind PS, Stephens LE. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pediatrics. 2004 Feb. 113(2):368-75. [Medline].

 
Previous
Next
 
Neonatal abstinence syndrome scoring form.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.