Neonates drug withdrawal

B. Neonatal drug withdrawal may occur In infants with chronic prenatal exposure to illicit or therapeutic drugs. The onset is usually within 72 hours of birth, but a postnatal onset as late as 14 days has been reported. Signs usually commence in the nursery, and infants are not discharged until clinically stable. However, with early discharge from nurseries becoming the norm, an infant in withdrawal may first present to an emergency department or acute care clinic. The presentation may be as mild as colic or severe as withdrawal seizures or profound diarrhea. 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Florfenicol (2) has been approved in Japan for the treatment of pseudo-tuberculosis caused by Pasteurellapiscicida and streptococcosis m. yeUowtail fish. The recommended dose is 10 mg/kg for up to one week and the drug withdrawal time is five days after cessation of treatment. Florfenicol is active in bovine respiratory disease caused by Pasteurella species and mastitis caused by Staphylococci and Streptococci. It is also effective in neonatal cohbacillosis caused by E. coli. The drug is being developed worldwide by Schering-Plough Animal Health for the treatment of aquatic and bovine diseases. 

Drug withdrawal reactions are liable to occur in neonates whose mothers are ingesting drugs of abuse or antidepressants of the SSRI type (p. 228). 

Indications Seizure disorders, anticonvulsants, anxiety, tension and insomnia, surgical adjuncts for conscious sedation or amnesia, skeletal muscle spasms or tremors, delirium, schizophrenia as an adjunct, nausea and vomiting induced by chemotherapy, neonatal opiate withdrawal Common drug examples ... 

Drug withdrawal A withdrawal syndrome has been described in a neonate born to a mother who was taking tramadol 400 mg/ day for chronic low back pain [179 ]. During the last weeks of pregnancy, the dose was reduced to 200 mg/day. At 35 hours of age, the neonate had signs of severe withdrawal. The symptoms occurred earlier... 

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). 

Methadone is extensively used in opioid withdrawal and maintenance programs (see Drug tolerance in this monograph), and has been safely used for this purpose in pregnancy, with only mild effects on the offspring (41). However, fetal exposure to methadone in utero can cause a neonatal abstinence syndrome after delivery. 

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. 

After delivery, the maternal response to drug treatment and, if appropriate, serum drug concentrations should be monitored, because the disposition of anticonvulsants can change. The neonate should be monitored for potential residual effects of transplacentally acquired anticonvulsants and, in the case of barbiturates and benzodiazepines, withdrawal symptoms such as irritability and feeding difficulties. 

Ratnayaka BD, DhaUwal H, Watkin S. Drug points. Neonatal convulsions after withdrawal of baclofen. BMJ 2001 323(7304) 85. 

Neonatal CNS depression, drug accumulation, and withdrawal symptoms possible. 

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

V. Neonates present specific problems, including unique pharmacokinetics and potentially severe withdrawal from prenatal drug exposure. 

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 Exposure to opioids in utero can lead to the development of the neonatal abstinence syndrome, especially in infants born to mothers who have misused these drugs. Neonatal abstinence syndrome in neonates bom to mothers taking treatment has been investigated in 68 neonates. Pre-delivery higher doses of maternal methadone were associated with an increased incidence of treatment for withdrawal and with longer episodes of neonatal abstinence syndrome. There was a dose-response relationship— for every 1 mg increase in last maternal methadone dosage before delivery, an extra 0.18 days of infant treatment for neonatal abstinence syndrome were required furthermore, breastfeeding reduced the duration of neonatal abstinence syndrome by 7.76 days [261. 

Reeds (45 = ) and Lipsitz (34 = ) reviewed withdrawal symptoms in newborn infants and proposed a narcotic withdrawal score for this group. Rothstein and Gold-blatt(48 =) described electrocardiographic abnormalities in neonates bom to heroin-and methadone-dependent women. Remen-teria et al. (46 = ) described multiple births in drug-addicted women. Bai et al. (3 ) and Santen et al. (49 = ) studied and reviewed narcotic-related menstrual dysfunction. 

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