Neonates opioid withdrawal

Convulsions occurred in a baby born to an opioid-dependent mother. This case is unusual, as convulsions due to neonatal opioid withdrawal do not usually occur in the first 24 hours after delivery it suggests that naloxone should be used with great caution in children born to opioid-dependent mothers (13). 

Franck L, Vilardi J. (1995). Assessment and management of opioid withdrawal in ill neonates. 

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. 

Tolerance and dependence may occur with prolonged use. Abrupt cessation in patients utilizing propoxyphene chronically may result in an opioid withdrawal syndrome in both adults and neonates. 

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. 

The neonatal abstinence syndrome occurs in 30-80% of infants whose mothers have taken opiates during pregnancy. The incidence is higher in those whose mothers have a history of opioid dependence and are taking methadone maintenance than in those who are taking methadone for chronic pain (39). The methadone blood concentration may be a useful predictor of the likelihood of severe withdrawal requiring treatment, but clinical assessment by a standardized scoring system is still required to determine the need to treat the neonatal abstinence syndrome (40). 

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. 

TREATMENT OF OPIOID OVERDOSAGE Naloxone hydrochloride should be used cautiously for opiate overdose because it also can precipitate withdrawal in dependent subjects and cause undesirable cardiovascular side effects. By carefully titrating the dose of naloxone, it usually is possible to antagonize the respiratory-depressant actions without eliciting a full withdrawal syndrome. The duration of action of naloxone is relatively short, and it often must be given repeatedly or by continuous infusion. Opioid antagonists also have been employed effectively to decrease neonatal respiratory depression secondary to the intravenous or intramuscular administration of opioids to the mother. In the neonate, the initial dose is 10 /ig/kg given intravenously, intramuscularly, or subcutaneously. 

Observational studies Tincture of opium is a preparation of powdered opium, which contains morphine, codeine, papaverine, and alcohol. It is used as an antidiarrheal agent, to treat neonatal abstinence syndrome, in the management of pain, and traditionally for the management of opioid dependency in some Asian countries. In an open study, opium-dependent subjects were allocated to three different doses of tincture of opium twice a day 10 ml (6.66 mg morphine equivalents n = 13), 20 ml (13.3 mg morphine equivalents n = 8), and 30 ml (20 mg morphine equivalents n = 11) [1 j. In all the subjects tincture of opium effectively suppressed withdrawal symptoms without causing significant adverse effects. 

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. 

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