Neonatal withdrawal

Paregoric [Camphorated Tincture of Opium] [C lll] [Narcotic Antidiarrheal] Uses D, Pain neonatal opiate withdrawal synd Action Narcotic Dose Adults. 5—10 mL PO daUy-qid PRN Peds. 0.25-0.5 mL/kg daily-qid Neonatal withdrawal 3-6 gtt PO q3-6 h PRN to relieve Sxs x 3-5 d, then taper ovo 2-4 wk Caution [B (D w/ prolonged use/high dose near term, +]... 

Methadone where indicated, maintenance suitable but sometimes detoxification if requested Buprenorphine safe and associated with less neonatal withdrawal Avoid benzodiazepines... 

The experience of pregnancy itself is often anxiety provoking, and symptoms sufficient to warrant drug therapy are common in this group ( 16). Although this discussion primarily focuses on the benzodiazepines (BZDs), antidepressants and buspirone may also be used for women of childbearing age with certain anxiety-related disorders. Perhaps the best-documented adverse effect of the BZDs is a neonatal withdrawal syndrome, which has been reported to occur with several of the agents (e.g., diazepam, alprazolam, and triazolam). In addition, there is a weak positive relationship between diazepam exposure and oral clefts ( 17). 

Gradual tapering of a BZD before delivery to minimize any neonatal withdrawal phenomena... 

Antidepressants, tricyclic Third Neonatal withdrawal symptoms have been reported in a few cases with clomipramine, desipramine, and imipramine... 

Table 7.7 CNS depressants associated with neonatal withdrawal syndrome...

Sanz EJ, De Las-Cuevas C, Bate A, Edwards R. Selective serotonin reuptake inhibitors in pregnant women and neonatal withdrawal syndrome a database analysis. Lancet 2005 365 482-87. 

Ostrea, E. M. and Chavez, C. S., Perinatal problems (excluding neonatal withdrawal) in maternal drug addiction a study of 830 cases, /. Pediatr., 94, 292, 1979. 

A withdrawal syndrome occurs in the newborn of dependent mothers. It is important not to attempt to reduce the mother s use of opioid late in pregnancy, as a more severe and unpredictable neonatal withdrawal syndrome may result. 

Hydroxyzine used in a fairly high dose (600 mg/day) in pregnancy has been reported to produce a neonatal withdrawal syndrome after delivery this was characterized primarily by hyperactivity and irritability (SEDA-2,151). 

A neonatal withdrawal syndrome has been described, with verification by the detection of pentazocine and its metabolites in the urine of both mother and baby. Within 4 hours of birth the child was irritable, jittery, and hypertonic, with a high-pitched cry, a voracious appetite, and frequent bowel movements. The symptoms improved over 3 days. The mother had abused parenteral pentazocine (23-46 mg) for the previous 10 years and injected the last dose of 46 mg some 10 hours before dehvery (10). 

Opium is used for analgesia, sedative-hypnotic narcosis, antiperistalsis, and in the treatment of neonatal withdrawal. It is also a drug of abuse. 

Martin, L, M.A. Lopez-Vilchez, A. Mur, O. Garcia-Algar, et al. 2007. Neonatal withdrawal syndrome after chronic maternal drinking of mate. Ther. Drug Monit. 29(1) 127-129. 

Fetotoxicity There have been reports of neonatal withdrawal symptoms with SSRIs, but httle is known of this phenomenon with other antidepressants. When seven mother-child pairs exposed to venlafaxine from the second trimester were studied p "], five of the neonates had a withdrawal syndrome, including tachypnea and respiratory distress the changes corresponded to falling plasma venlafaxine concentrations. The neonate exposed to the highest maternal dose of venlafaxine (300 mg/day) had the most severe and most persistent signs. 

O Mara K, Gal P, DaVanzo C. Treatment of neonatal withdrawal with clonidine after long-term, high-dose maternal use of tramadol. Arm Pharmacother 2010 44 1342-4. 

NB SSRls in 3rd trimester are associated with neonatal withdrawal, toxicity or persistent pulmonary h5 ertension... 

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