NEONATAL ABSTINENCE SYNDROME CLINICAL PRACTICE GUIDELINES FOR ONTARIO

Main Article Content

Kimberly Dow
Alice Ordean
Jodie Murphy-Oikonen
Jodie Pereira
Gideon Koren
Henry Roukema
Peter Selby
Ruth Turner

Keywords

Opioid, methadone, drug withdrawal, neonate, abstinence syndrome

Abstract

Ontario’s clinical practice guidelines for neonatal abstinence syndrome (NAS) provide evidence-informed recommendations that address the needs of substance using pregnant women and newborns at risk of NAS. NAS is a complex and multifaceted issue that is escalating along with rapidly rising opioid use in Ontario. Reducing the incidence and impact of NAS requires immediate action in order to improve the care of affected women and infants. This includes optimizing and standardizing treatment strategies, assessing and managing social risk, better monitoring of prescribing practices and facilitating the implementation of better treatment and prevention strategies as they become available. These clinical practice guidelines provide the framework to inform and support the development of a coordinated strategy to address this important issue and to promote safe and effective care.

Abstract 166 | PDF Downloads 132

References

1. American Academy of Paediatrics, Committee on Drugs (1998). Neonatal drug withdrawal. Pediatrics 1998; 101(6):1079-1088.
2. Murphy-Oikonen J, Montelpare W, et al. Identifying infants at risk for Neonatal Abstinence Syndrome: A retrospective cohort comparison study of 3 screening approaches. J Perinat Neonatal Nurs 2010;24(4):366-372.
3. Ontario Narcotic Strategy. http://www.health.gov.on.ca/en/public/programs/drug s/ons/docs/op_reduce_misuse_abuse.pdf Accessed on August 27, 2010
4. Woolf SH, Battista RN, Angerson GM, Logan AG, Eel W, Canadian task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. Can Med Assoc J 2003;169(3):207-9.
5. http://www.news.ontario.ca/mohltc/en/2010/08/ ontario-moving-to-reduce-abuse-of-prescriptionnarcotics. html
6. Ontario Narcotic Strategy. http://www.health.gov.on.ca/en/public/programs /drugs/ons/
7. College of Physicians and Surgeons of Ontario. Methadone Maintenance Treatment Program Fact Sheet. Dec 2009.
8. http://www.news.ontario.ca/mohltc/en/2010/08/ ontario-moving-to-reduce-abuse-of-prescriptionnarcotics. html
9. Marcellus M. Care of substance-exposed infants: The current state of practice in Canadian hospitals. Journal of Perinatal and Neonatal Nursing 2002;16(3):51-68.
10. Public Health Agency of Canada. What Mothers Say: The Canadian Maternity Experiences Survey. Ottawa, 2009.
11. Ialomiteanu AR, Adlaf EM, Mann RE, Rehm J. (2011). CAMH Monitor eReport: Addiction and Mental Health Indicators Among Ontario Adults, 1977-2009 (CAMH Research Document Series No. 31). Toronto: Centre for Addiction and Mental Health.
12. Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
13. Ontario’s Narcotic Strategy. http://news.ontario.ca/mohltc/en/2010/11/ontario s-narcotics-strategy.html Accessed on Nov 29, 2010.
14. Shieh C, Kravitz M. Severity of drug use, initiation of prenatal care, and maternal-fetal attachment in pregnant marijuana and cocaine/heroin users. J Obstet Gynecol and Neonatal Nursing 2006; 35(4):499-508.
15. Abrahams RR, MacKay-Dunn MH, Nevmerjitskaia V, MacRae GS, Payne SP, Hodgson ZG. An evaluation of rooming-in among substance-exposed newborns in British Columbia. JOGC 2010;(9): 866-871.
16. Wong S, Ordean A, Kahan M. Substance use in pregnancy. JOGC 2011;33(4):367-384.
17. Jansson LM, Velez M. Understanding and treating substance abusers and their infants. Infants Young Child 1999;11:79–89.
18. Goff M, O'Connor M. Perinatal care of women maintained on methadone. Journal of Midwifery & Women's Health 2007;52(3):e23-e26. doi: 10.1016/j.jmwh.2007.02.009
19. Ward J, Hall W, Mattick RP. Role of maintenance treatment in opioid dependence. Lancet 1999;353(9148):221-226. doi: 10.1016/S0140-6736(98)05356-2.
20. Hudak ML, Tan RC. Neonatal drug withdrawal. Pediatrics 2012;129:e540-e560.
21. 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. American Journal of Obstetrics and Gynecology 2009;200(1):70-e1- 70.e5. doi: 10.1016/j.ajog.2008.08.041
22. Pizarro D, Habli M, Grier M, Bombrys A, Sibai B, Livingston J. Higher maternal doses of methadone does not increase neonatal abstinence syndrome. Journal of Substance Abuse Treatment 2011; 40(3):295-298. doi: 10.1016/j.jsat.2010.11.007
23. Cleary BJ, Donnelly J, Strawbridge J, Gallagher PJ, Fahey T, Clarke M, Murphy DJ. Methadone dose and neonatal abstinence syndrome – systematic review and meta-analysis. Addiction 2010; 105(12):2071-2084.
24. Black KI, Stephens C, Haber PS, Lintzeris N. Unplanned pregnancy and contraceptive use in women attending drug treatment services. Australian and New Zealand Journal of Obstetrics and Gynaecology 2012;52:146-150.
25. Jones HE, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. NEJM 2010;363(24):2320-2331.
26. Kraft WK, et al. Sublingual buprenorphine for treatment of neonatal abstinence syndrome: A randomized trial. Pediatrics 2010;122:e601-7.
27. Friedman SH, Heneghan A, Rosenthal M. Disposition and health outcomes among infants born to mothers with no prenatal care. Child Abuse & Neglect 2009;33(2):116-122. doi:10.1016/j.chiabu.2008.05.009
28. Murphy-Oikonen J, Montelpare W, Southon S, Bertoldo L, Persichino N. Identifying infants at risk for Neonatal Abstinence Syndrome. J Perinat Neonat Nurs 2010;24(4):366-372.
29. Koren G, Hutson J, Gareri J. Novel methods for the detection of drug and alcohol exposure during pregnancy: implications for maternal and child health. Clin Pharmacol Ther 2008 Apr;83:631-4.
30. Koren G, Nulman I, Chudley AE, Loocke C. Fetal alcohol spectrum disorder. CMAJ 2003 25;169(11):1181-5.
31. Brown HL, Britton KA, Mahaffey D, Rizendine E, Hiett AK, Turnquest MA. Methadone maintenance in pregnancy: A reappraisal. Am J Obs Gynec 1998;179(2):459-463.
32. Dickens BM. Legal and ethical considerations in meconium testing for fetal exposure to alcohol Popul Ther Clin Pharmacol 2011;18(3):e471-4.
33. Finnegan LP. Neonatal abstinence. In: Nelson NM, ed. Current Therapy in Neonatal-Perinatal Medicine. 2nd ed. Toronto, Ontario: BC Decker Inc; 1990.
34. American Academy of Pediatrics, Committee on Drugs. Neonatal Drug Withdrawal Policy. Pediatrics 2012;129(2):e540-560.
35. Jansson L, Velez M, Harrow C. The opioid exposed newborn: Assessment and pharmacologic management. J Opioid Manag 2009;5(1):54.
36. Ohgi S, Akiyama T, Arisawa K, Shigemori K. Randomised controlled trial of swaddling versus massage in the management of excessive crying in infants with cerebral injuries. Arch Dis Child 2004Mar;89(3):212-6.
37. Saylor C, Lippa B, Lee G. Drug-exposed infants at home: Strategies and supports. Public Health Nurs 1991Mar;8(1):33-8.
38. van Sleuwen BE, Engelberts AC, Boere- Boonekamp MM, Kuis W, Schulpen TW, L'Hoir MP. Swaddling: a systematic review. Pediatrics 2007 Oct;120(4):e1097-106.
39. Ballard JL. Treatment of neonatal abstinence syndrome with breast milk containing methadone. J Perinat Neonatal Nurs 2002 Mar;15(4):76-85.
40. 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 mother. Pediatrics 2006 June;Vol(117)6:e1163- e1169.
41. Jansson LM, Choo R, Velez ML, Harrow C, Schroeder R, Shakleya DM, Huestis MA. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 2008 January;Vol(121) No. 1: 106-114.
42. Velez M, Jansson LM. The opioid dependent mother and newborn dyad: non-pharmacologic care. J Addict Med 2008 Sep;1;2(3):113-120.
43. Marcellus L. Care of substance-exposed infants: the current state of practice in Canadian hospitals. J Perinat Neonatal Nurs 2002 Dec;16(3):51-68.
44. Oei J, Lui K. Management of the newborn infant affected by maternal episodes and other drugs in pregnancy. Journ Ped & Child Health 2007;43:9-18.
45. Beauman SS. Identification and management of neonatal abstinence syndrome. Journal of Infusion Nursing 2005;28(3):159-167.
46. D'Apolito K. Comparison of a rocking bed and standard bed for decreasing withdrawal symptoms in drug-exposed infants. Am J Matern Child Nurs 1999 May-Jun;24(3):138-44.
47. O’Grady MJ, et al. Management of neonatal abstinence syndrome: a national survey and review of practice. Arch Dis Child Fetal Neonatal Ed 2009;94:F249-52.
48. Oei J, Lui K. Management of the newborn infant affected by maternal opiates and other drugs of dependency. J Ped Child Health 2007;43:9-18.
49. Lainwala S, et al. A retrospective study of length of hospital stay of infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care 2005; 5:265-72.
50. Coyle MG, et al. Diluted tincture of opium (DTO) and phenobarbital versus DTO alone for neonatal opiate withdrawal in term infants. J Pediatr 2002;140:561-4.
51. Osborn DA, et al. Sedatives for opiate withdrawal n term infants. Cochrane Database of Systematic Reviews 2010;10.
52. Agthe AG, et al. Clonidine as an adjunct therapy to opioids for neonatal abstinence syndrome: A randomized, controlled trial. Pediatrics 2009;123:e849-56.
53. Esmaeili A, Keinhorst AK, Schuster T, Schlosser R, Bastanier C. Treatment of neonatal abstinence syndrome with clonidine and chloral hydrate. Acta Paediatrica 2009 Oct 1-6.(on line)
54. Bandstra ES, Morrow CE, Mansoor E, Accornero VH. Prenatal drug exposure: infant and toddler outcomes. J Addict Dis 2010;29(2):245-258.
55. Schempf AH, Strobino DM. Drug use and limited prenatal care: An examination of responsible barriers. American Journal of Obstetrics and Gynecology 2009;200(4):412.e1- 412. e10. doi: 10.1016/j.ajog.2008.10.055