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Neonatal Abstinence Syndrome: Taking Care of Mom and Baby

Neonatal Abstinence Syndrome: Taking Care of Mom and Baby. Heather Rodman, PharmD PGY-2 Pediatric Pharmacy Resident Peyton Manning Children’s Hospital St. Vincent Hospital and Health Services September 2014

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Neonatal Abstinence Syndrome: Taking Care of Mom and Baby

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  1. Neonatal Abstinence Syndrome: Taking Care of Mom and Baby Heather Rodman, PharmDPGY-2 Pediatric Pharmacy ResidentPeyton Manning Children’s HospitalSt. Vincent Hospital and Health ServicesSeptember 2014 This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation.

  2. Definition • Withdrawal after prenatal exposure to certain drugs • Dysregulation of the central, autonomic, and gastrointestinal functioning of the neonate Hudak, ML, et al. Pediatrics. 2012; 129: e540-e560. Sutter MB, et al. ObstetGynecolClin N Am. 2014; 41: 317-334. Logan BA, et al. ClinObstet Gynecol. March 2013; 56(1): 186-192.

  3. Signs / Symptoms Hudak, ML, et al. Pediatrics. 2012; 129: e540-e560. Sutter MB, et al. ObstetGynecolClin N Am. 2014; 41: 317-334. Logan BA, et al. ClinObstet Gynecol. March 2013; 56(1): 186-192.

  4. Taking Care of Mom

  5. Prenatal Care • Enrollment in an opioid maintenance program • Minimizes cravings and optimizes maternal health • Prevents fetal stress and suppresses withdrawal • Anticipatory neonatal withdrawal • Methadone is most commonly chosen • Buprenorphine may shorten treatment duration and hospital stay of the neonate • Increased dropout rate with buprenorphine • Increased doses may be required during 3rd trimester Hudak, ML, et al. Pediatrics. 2012; 129: e540-e560. Logan BA, et al. ClinObstet Gynecol. March 2013; 56(1): 186-192. Jones HE, et al. NEJM. Dec 2010; 363(24): 2320-2331.

  6. Addiction Resources • Indiana Addictions Issues Coalition (IAIC) • http://recoveryindiana.org/index.php • United States Recovery • List of support groups and treatment centers by state • http://www.usrecovery.info/index.htm • National Institute on Drug Abuse (NIH) • Resources for professionals, patients, and families • http://www.drugabuse.gov/ • National Council on Alcoholism and Drug Dependence • http://ncadd.org/index.php • American Congress of Obstetricians and Gynecologists (ACOG) • http://www.acog.org/Patients/FAQs/Tobacco-Alcohol-Drugs-and-Pregnancy

  7. Taking Care of The Neonate

  8. Non-Pharmacologic Measures • Dark, quiet environment • Swaddling and comforting techniques • Swaying, rocking • Skin-to-skin contact (parents only) • Music therapy • Small but frequent feedings • Breast feeding approved by AAP • Contraindications: HIV (+) • Relative contraindications: Hepatitis C (+), heroin, cocaine, alcohol abuse • Family education Hudak, ML, et al. Pediatrics. 2012; 129: e540-e560. Sutter MB, et al. ObstetGynecolClin N Am. 2014; 41: 317-334.

  9. Pharmacologic Treatment Options Langenfeld S, et al. Drug Alcohol Depend. 2005; 77(1): 31-36. Agthe AG, et al. Pediatrics. May 2009; 123(5): e849-e856. Kraft WK, et al. PediatrClin N Am. 2012; 59: 1147-1165. Hudak, ML, et al. Pediatrics. 2012; 129: e540-e560. Sutter MB, et al. ObstetGynecolClin N Am. 2014; 41: 317-334.

  10. Langenfeld S, et al. Drug Alcohol Depend. 2005; 77(1): 31-36. Agthe AG, et al. Pediatrics. May 2009; 123(5): e849-e856. Kraft WK, et al. PediatrClin N Am. 2012; 59: 1147-1165. Hudak, ML, et al. Pediatrics. 2012; 129: e540-e560. Sutter MB, et al. ObstetGynecolClin N Am. 2014; 41: 317-334.

  11. Long-Term Outcomes • Difficult to evaluate • Confounding variables • Withdrawal seizures respond to opiates and do not necessarily carry an increased risk of poor outcomes • Neurocognitive delays possible during infancy • Working memory updating - Resolved at ~ 7 months • Regulation and quality of movement • Excitability • Delay in milestones: Independent sitting, crawling Hudak, ML, et al. Pediatrics. 2012; 129: e540-e560. Sutter MB, et al. ObstetGynecolClin N Am. 2014; 41: 317-334. Logan BA, et al. ClinObstet Gynecol. March 2013; 56(1): 186-192.

  12. Take Home Points • Pregnant women on methadone may require higher doses during pregnancy • Buprenorphine is now considered a safe, alternative option for pregnant women enrolled in an opioid maintenance program • Breastfeeding is beneficial for NAS even while the mom is still enrolled in the maintenance program

  13. Assessment Question • During which trimester is a pregnant woman most likely to require her highest dose of methadone? • 1st Trimester • 2nd Trimester • 3rd Trimester

  14. Questions?

  15. Thank You Heather Rodman, PharmDPGY-2 Pediatric Pharmacy ResidentPeyton Manning Children’s HospitalSt. Vincent Hospital and Health ServicesSeptember 2014

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