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1.
Pediatrics ; 154(1)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38899388

RESUMO

BACKGROUND AND OBJECTIVES: In November 2020, the American Academy of Pediatrics published guidelines for management of neonatal opioid withdrawal syndrome (NOWS), recommending nonpharmacologic treatment as the first-line approach, unless pharmacologic treatment is needed for severe NOWS. Using data from tertiary care pediatric hospitals, we examined the impact of the guidelines on use of pharmacotherapy, length of stay, and NICU admission for infants with NOWS. METHODS: We extracted birth hospitalization data for newborns diagnosed with NOWS discharged from 2019 to 2022 from the Pediatric Health Information System. We compared hospital utilization and pharmacologic treatment pre- and postguidelines and used interrupted time series regression to examine trends over time. RESULTS: We included N = 824 newborns (n = 434 pre, n = 390 post) with NOWS from 11 hospitals. The use of pharmacologic treatment was significantly lower in the postguidelines period (59.0% pre versus 50.3% post; P = .01). Median length of stay was similar pre and post (P = .55). NICU admission was significantly lower in the postguidelines period (78.6% pre versus 46.7% post; P < .001), with an immediate decrease (ß = -23.0%; P < .001) and a decrease over time in the postguidelines period (ß = -0.7% per month; P = .03). Most hospitals reduced pharmacologic treatment (8 of 11; 73%) and NICU use (10 of 11; 91%) postguidelines. CONCLUSIONS: There was a reduction in the use of pharmacologic treatment and NICU utilization for infants with NOWS after the release of American Academy of Pediatrics guidelines for NOWS management.


Assuntos
Tempo de Internação , Síndrome de Abstinência Neonatal , Guias de Prática Clínica como Assunto , Humanos , Recém-Nascido , Síndrome de Abstinência Neonatal/terapia , Síndrome de Abstinência Neonatal/tratamento farmacológico , Feminino , Masculino , Tempo de Internação/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal , Hospitalização , Analgésicos Opioides/uso terapêutico , Estudos Retrospectivos , Análise de Séries Temporais Interrompida , Estados Unidos
2.
Pediatrics ; 154(1)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38853654

RESUMO

OBJECTIVE: To elicit expert consensus on quality indicators for the hospital-based care of opioid-exposed infants. METHODS: We used the ExpertLens online platform to conduct a 3-round modified Delphi panel. Expert panelists included health care providers, parents in recovery, quality experts, and public health experts. We identified 49 candidate quality indicators from a literature review and environmental scan. A total of 32 experts rated the importance and feasibility of the indicators using a 9-point Likert scale (Round 1), reviewed and discussed the initial ratings (round 2), and revised their original ratings (Round 3). Numeric scores corresponded with descriptive ratings of "low" (1-3), "uncertain" (4-6), or "high" (7-9). We measured consensus using the RAND/UCLA Appropriateness Method. RESULTS: Candidate quality indicators assessed structures, processes, and outcomes in multiple domains of clinical care. After the final round, 36 indicators were rated "high" on importance and feasibility. Experts had strong consensus on the importance of quality indicators to assess universal screening of pregnant people for substance use disorder, hospital staff training, standardized assessment for neonatal opioid withdrawal syndrome, nonpharmacologic interventions, and transitions of care. For indicators focused on processes and outcomes, experts saw feasibility as dependent on the information routinely documented in electronic medical records or billing records. To present a more complete picture of hospital quality, experts suggested development of composite measures that summarize quality across multiple indicators. CONCLUSIONS: A panel of experts reached consensus on a range of quality indicators for hospital-based care of opioid-exposed infants, with potential for use in national benchmarking, intervention studies, or hospital performance measurement.


Assuntos
Analgésicos Opioides , Consenso , Técnica Delphi , Indicadores de Qualidade em Assistência à Saúde , Humanos , Recém-Nascido , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Gravidez , Feminino , Síndrome de Abstinência Neonatal , Lactente , Hospitais/normas
3.
Mo Med ; 121(3): 212-219, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38854608

RESUMO

Neonatal abstinence syndrome (NAS)/Neonatal opioid withdrawal syndrome (NOWS) and substance abuse disorder (SUD) rates are undeniably linked with the outcomes of mothers and babies. This essential relationship emphasizes the importance of quality improvement work done jointly, treating mother and infant as a dyad, not as separate entities. In 2020 the Missouri Hospital Association (MHA) partnered with Show-Me ECHO, a state-funded telehealth project, to initiate a state-wide quality improvement (QI) project to improve and standardize care delivery to the mother-baby dyad affected by SUD. Fourteen hospitals participated across the state of Missouri from January 2021 through December 2022. Through the ECHO model and technical implementation support, 100% of collaborative participating birth centers implemented a non-pharmacologic policy for the care of the substance-exposed newborn. In addition, maternal SUD screening increased by 67.3% (57.5% to 96.2%), infant transfer rates were reduced by 24%, and safe care discharge plans increased by 37% for infants and 144% for mothers. Further, the collaboration between MHA and the Show-Me ECHO demonstrates the feasibility of cross-sector efforts to create synergy to improve and standardize the care of the mother-infant dyad affected by SUD.


Assuntos
Síndrome de Abstinência Neonatal , Melhoria de Qualidade , Transtornos Relacionados ao Uso de Substâncias , Humanos , Missouri , Síndrome de Abstinência Neonatal/terapia , Recém-Nascido , Feminino , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Gravidez , Mães , Telemedicina
4.
Crit Care Nurs Clin North Am ; 36(2): 223-233, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38705690

RESUMO

The increase in substance use during pregnancy results in a higher incidence of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS), straining health care and social systems and creating an economic burden. There is a paradigm shift in transitioning the care approach for NAS/NOWS from a medical model of care to a family-centered individualized non-pharmacological care approach with non-pharmacological interventions as the first line of treatment. Supporting families after birth with a nurturing environment and providing them with a toolbox of non-pharmacological interventions prepares them for the transition from hospital to home.


Assuntos
Síndrome de Abstinência Neonatal , Transtornos Relacionados ao Uso de Opioides , Humanos , Síndrome de Abstinência Neonatal/terapia , Recém-Nascido , Transtornos Relacionados ao Uso de Opioides/terapia , Gravidez , Feminino , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/efeitos adversos , Cuidado Transicional , Síndrome de Abstinência a Substâncias/terapia , Complicações na Gravidez/terapia
5.
Hosp Pediatr ; 14(6): 438-447, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38804051

RESUMO

OBJECTIVE: Observational studies examining outcomes among opioid-exposed infants are limited by phenotype algorithms that may under identify opioid-exposed infants without neonatal opioid withdrawal syndrome (NOWS). We developed and validated the performance of different phenotype algorithms to identify opioid-exposed infants using electronic health record data. METHODS: We developed phenotype algorithms for the identification of opioid-exposed infants among a population of birthing person-infant dyads from an academic health care system (2010-2022). We derived phenotype algorithms from combinations of 6 unique indicators of in utero opioid exposure, including those from the infant record (NOWS or opioid-exposure diagnosis, positive toxicology) and birthing person record (opioid use disorder diagnosis, opioid drug exposure record, opioid listed on medication reconciliation, positive toxicology). We determined the positive predictive value (PPV) and 95% confidence interval for each phenotype algorithm using medical record review as the gold standard. RESULTS: Among 41 047 dyads meeting exclusion criteria, we identified 1558 infants (3.80%) with evidence of at least 1 indicator for opioid exposure and 32 (0.08%) meeting all 6 indicators of the phenotype algorithm. Among the sample of dyads randomly selected for review (n = 600), the PPV for the phenotype requiring only a single indicator was 95.4% (confidence interval: 93.3-96.8) with varying PPVs for the other phenotype algorithms derived from a combination of infant and birthing person indicators (PPV range: 95.4-100.0). CONCLUSIONS: Opioid-exposed infants can be accurately identified using electronic health record data. Our publicly available phenotype algorithms can be used to conduct research examining outcomes among opioid-exposed infants with and without NOWS.


Assuntos
Algoritmos , Registros Eletrônicos de Saúde , Síndrome de Abstinência Neonatal , Fenótipo , Humanos , Recém-Nascido , Feminino , Gravidez , Síndrome de Abstinência Neonatal/diagnóstico , Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Masculino
6.
Semin Perinatol ; 48(3): 151907, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38702266

RESUMO

The care of the dyad affected by opioid use disorder (OUD) requires a multi-disciplinary approach that can be challenging for institutions to develop and maintain. However, over the years, many institutions have developed quality improvement (QI) initiatives aimed at improving outcomes for the mother, baby, and family. Over time, QI efforts targeting OUD in the perinatal period have evolved from focusing separately on the mother and baby to efforts addressing care of the dyad and family during pregnancy, delivery, and postpartum. Here, we review recent and impactful QI initiatives that serve as examples of work improving outcomes for this population. Further, we advocate that this work be done through a racial equity lens, given ongoing inequities in the care of particularly non-white populations with substance use disorders. Through QI frameworks, even small interventions can result in meaningful changes to the care of babies and families and improved outcomes.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Melhoria de Qualidade , Humanos , Gravidez , Feminino , Recém-Nascido , Assistência Perinatal/normas , Assistência Perinatal/métodos , Complicações na Gravidez , Síndrome de Abstinência Neonatal/terapia
7.
Sci Adv ; 10(19): eadg9674, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38718116

RESUMO

Prenatal opioid exposure is an established public health problem, in particular among Medicaid-covered births. Yet, existing prevalence rates are plausibly underestimated. We leverage extensive linked longitudinal administrative data for all Medicaid-covered live births in Wisconsin from 2010 to 2019 to estimate a range of prevalence rates using an innovative strategy that jointly accounts for both likelihood of exposure and potential risk to prenatal development. We find that 20.8% of infants may have been prenatally exposed to opioids, with 1.7% diagnosed with neonatal abstinence syndrome and an additional 1.2% having a high combined likelihood of exposure and potential risk to prenatal development, 2.6% a moderate combined likelihood and risk, and 15.3% a low or uncertain combined likelihood and risk. We assess improvements in prevalence estimates based on our nuanced classification relative to those of prior studies. Our strategy could be broadly used to quantify the scope of the opioid crisis for pregnant populations, target interventions, and promote child health and development.


Assuntos
Analgésicos Opioides , Medicaid , Efeitos Tardios da Exposição Pré-Natal , Humanos , Wisconsin/epidemiologia , Gravidez , Feminino , Estados Unidos/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Analgésicos Opioides/efeitos adversos , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Prevalência , Adulto , Fatores de Risco
8.
Crit Care Nurs Clin North Am ; 36(2): 235-249, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38705691

RESUMO

The number of infants diagnosed with neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) has increased. The expression of NAS/NOWS symptoms differs and typically begins within the first few days of life, considered a critical period for feeding skill establishment, nourishment, and attachment. Non-pharmacologic interventions may be deployed to reduce or eliminate the need for replacement opioids while targeting outcomes like feeding dysfunction. Critical care providers can benefit from a structured examination of disordered feeding experiences to inform their selection of non-pharmacologic interventions. This structure can be provided using the Ecology of Human Performance model.


Assuntos
Analgésicos Opioides , Síndrome de Abstinência Neonatal , Humanos , Síndrome de Abstinência Neonatal/terapia , Recém-Nascido , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides
9.
Neoreviews ; 25(6): e325-e337, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38821910

RESUMO

The overall prevalence of opiate use has been increasing, currently affecting approximately 0.6% of the global population and resulting in a significant proportion of infants being born with prenatal opioid exposure. Animal and human models of prenatal opioid exposure demonstrate detrimental effects on brain anatomy as well as neurodevelopment. Less is known about the neurologic sequelae of postnatal opioid exposure in hospitalized infants. In this review, we summarize our current understanding of the impact of prenatal and postnatal opioid exposure on the brain and on neurodevelopment outcomes. We also identify resources and management strategies that may help mitigate neurodevelopmental delays and deficits associated with opioid exposure in this vulnerable population.


Assuntos
Analgésicos Opioides , Efeitos Tardios da Exposição Pré-Natal , Humanos , Recém-Nascido , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Feminino , Analgésicos Opioides/efeitos adversos , Transtornos Relacionados ao Uso de Opioides , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/crescimento & desenvolvimento , Síndrome de Abstinência Neonatal/tratamento farmacológico , Síndrome de Abstinência Neonatal/diagnóstico
10.
J Matern Fetal Neonatal Med ; 37(1): 2337711, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38616176

RESUMO

OBJECTIVE: Evaluate maternal and neonatal outcomes after buprenorphine wean compared to patients maintained on buprenorphine throughout pregnancy. METHODS: Prospective cohort study of pregnant patients with opioid use disorder enrolled in a multidisciplinary treatment program between 2015 and 2022. All patients were offered Medications to treat Opioid Use Disorder (MOUD) primarily with buprenorphine. Patients had at least 2 prenatal visits and negative urine drug tests (UDT) prior to weaning. The experimental group underwent a buprenorphine wean greater than 20% of their baseline dose. The control group was maintained on buprenorphine throughout the pregnancy. Relapse was defined as patient reported use or positive UDT during weekly assessments. Mass spectrophotometer was used for detection of drugs in samples. Fisher's exact tests were used to compare outcomes in weaned and control groups. RESULTS: 334 of 456 (73%) patients were treated with buprenorphine during pregnancy, with 39 in the experimental group and 295 in the control group. The mean dose for buprenorphine was similar between the groups (wean: 10.6 mg ± 5.6 vs. control: 10.3 mg ± 4.6, p = 0.76) but was significantly lower at delivery (wean: 4.4 ± 4.6 mg vs. control: 13.0 ± 4.7, p < 0.0001). Mean gestational age at initiation of the buprenorphine wean was 22.7 weeks. 10 of 39 (26%) who weaned were able to completely discontinue buprenorphine prior to delivery. Demographic data was similar between the groups, including overdose history. Overdose history at time of enrollment had a higher trend in the non-weaning group. neonatal opioid withdrawal syndrome (NOWS) treatment was significantly lower in the wean group (23 vs. 47%, p = 0.006), as was highest Finnegan score (9.6 ± 4.5 vs. 12.3 ± 4.0, p = 0.0003). Birthweight percentile was significantly higher in the wean group (44.3 ± 29.9 vs. 34.8 ± 24.4, p = 0.03). Gestational age at delivery, mode of delivery, and complications (HTN, DM, preterm labor, or short cervix) at delivery did not significantly differ between the groups. CONCLUSION: Despite counseling to stay on buprenorphine, there are patients who desire to wean. The NOWS rate in the weaned cohort was significantly lower than the controls with no observed increase in maternal or neonatal morbidity. There were no maternal overdoses or deaths during the pregnancy. Larger studies are needed to evaluate this approach.


Assuntos
Buprenorfina , Síndrome de Abstinência Neonatal , Transtornos Relacionados ao Uso de Opioides , Feminino , Recém-Nascido , Gravidez , Humanos , Lactente , Estudos Prospectivos , Desmame , Peso ao Nascer , Buprenorfina/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
11.
Trends Neurosci ; 47(5): 367-382, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38614891

RESUMO

Neonatal opioid withdrawal syndrome (NOWS) is a growing public health concern. The complexity of in utero opioid exposure in clinical studies makes it difficult to investigate underlying mechanisms that could ultimately inform early diagnosis and treatments. Clinical studies are unable to dissociate the influence of maternal polypharmacy or the environment from direct effects of in utero opioid exposure, highlighting the need for effective animal models. Early animal models of prenatal opioid exposure primarily used the prototypical opioid, morphine, and opioid exposure that was often limited to a narrow period during gestation. In recent years, the number of preclinical studies has grown rapidly. Newer models utilize both prescription and nonprescription opioids and vary the onset and duration of opioid exposure. In this review, we summarize novel prenatal opioid exposure models developed in recent years and attempt to reconcile results between studies while critically identifying gaps within the current literature.


Assuntos
Analgésicos Opioides , Modelos Animais de Doenças , Efeitos Tardios da Exposição Pré-Natal , Animais , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Gravidez , Feminino , Analgésicos Opioides/efeitos adversos , Humanos , Síndrome de Abstinência Neonatal , Transtornos Relacionados ao Uso de Opioides
12.
Eur J Obstet Gynecol Reprod Biol ; 297: 106-110, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38608352

RESUMO

OBJECTIVE: To get information on subcutaneous extended-release buprenorphine as opioid maintenance treatment during pregnancy, we compared it to orally administered buprenorphine and buprenorphine-naloxone treatments. We hypothesized that maternal and neonatal outcomes do not differ between the treatment groups. Study design In this population-based cohort study, 60 pregnant individuals receiving non-changed opioid maintenance treatment for opioid use disorder with a buprenorphine product from the time before conception to the time after delivery and their newborns were included. They were divided into three groups based on the pharmacotherapy with subcutaneous extended-release buprenorphine, sublingual buprenorphine, or buprenorphine-naloxone. Statistical analyses were conducted using Fischer's exact tests, ANOVA tests, and Kruskal-Wallis tests. All the statistical tests were two-tailed. RESULTS: The frequency of pregnancy or delivery complications did not significantly differ between the group receiving extended-release buprenorphine and the other groups. During pregnancy, 38 % of the women used illicit drugs concomitantly, with equal frequency in the extended-release buprenorphine group and the other groups. Of the neonates, 93 % were born full-term and 90 % got at least eight Apgar points in one minute age, without significant differences between the groups (p = 0.57). The need for pharmacotherapy for neonatal opioid withdrawal syndrome was the lowest in the extended-release buprenorphine group (25 %) and highest in the sublingual buprenorphine group (67 %). Still, the difference between the treatment groups did not reach statistical significance (p = 0.17). Among all neonates, the breastfed infants were less likely to receive pharmacotherapy for withdrawal symptoms than the formula-fed ones (p = 0.048). CONCLUSIONS: Extended-release buprenorphine with steady drug concentration seems to be a promising pharmacotherapy option during pregnancy for mothers. Maternal health during pregnancy may contribute to the well-being of newborns. Larger trials are urgently needed to confirm these results..


Assuntos
Buprenorfina , Preparações de Ação Retardada , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Complicações na Gravidez , Humanos , Feminino , Gravidez , Adulto , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Tratamento de Substituição de Opiáceos/métodos , Recém-Nascido , Buprenorfina/administração & dosagem , Buprenorfina/uso terapêutico , Complicações na Gravidez/tratamento farmacológico , Administração Oral , Síndrome de Abstinência Neonatal/tratamento farmacológico , Resultado da Gravidez , Administração Sublingual , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/uso terapêutico , Analgésicos Opioides/administração & dosagem , Estudos de Coortes , Adulto Jovem , Combinação Buprenorfina e Naloxona/administração & dosagem , Combinação Buprenorfina e Naloxona/uso terapêutico
13.
BMC Pediatr ; 24(1): 258, 2024 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-38641785

RESUMO

BACKGROUND: The incidence of neonatal opiate withdrawal syndrome (NOWS) in the US has grown dramatically over the past two decades. Many rural hospitals not equipped to manage these patients transfer them to hospitals in bigger cities. METHODS: We created a curriculum, the NOWS-NM Program, a web-based curriculum training in best practices. To evaluate the curriculum, we conducted pre- and post-surveys of NOWS knowledge, attitudes, and care practices, plus post-curriculum interviews and focus groups. RESULTS: Fourteen participants completed both pre- and post-curriculum surveys. They indicated an increase in knowledge and care practices. A small number of respondents expressed negative attitudes about parents of infants with NOWS at pre-test, the training curriculum appeared to have no impact on such attitudes at post-test. Sixteen participants participated in focus groups or interviews. Qualitative data reinforced the positive quantitative results and contradicted the negative survey results, respondents reported that the program did reduce stigma and improve provider/staff interactions with patients. CONCLUSIONS: This curriculum demonstrated positive impacts on NOWS knowledge and care practices. Incorporating focus on core concepts of trauma-informed care and self-regulation in future iterations of the curriculum may strengthen the opportunity to change attitudes and address the needs expressed by participants and improve care of families and babies with NOWS.


Assuntos
Analgésicos Opioides , Síndrome de Abstinência Neonatal , Lactente , Humanos , Recém-Nascido , Hospitais Rurais , Síndrome de Abstinência Neonatal/tratamento farmacológico , Currículo , Internet
14.
JAMA Pediatr ; 178(6): 525-532, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38619854

RESUMO

Importance: The function-based eat, sleep, console (ESC) care approach substantially reduces the proportion of infants who receive pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). This reduction has led to concerns for increased postnatal opioid exposure in infants who receive pharmacologic treatment. However, the effect of the ESC care approach on hospital outcomes for infants pharmacologically treated for NOWS is currently unknown. Objective: To evaluate differences in opioid exposure and total length of hospital stay (LOS) for pharmacologically treated infants managed with the ESC care approach vs usual care with the Finnegan tool. Design, Setting, and Participants: This post hoc subgroup analysis involved infants pharmacologically treated in ESC-NOW, a stepped-wedge cluster randomized clinical trial conducted at 26 US hospitals. Hospitals maintained pretrial practices for pharmacologic treatment, including opioid type, scheduled opioid dosing, and use of adjuvant medications. Infants were born at 36 weeks' gestation or later, had evidence of antenatal opioid exposure, and received opioid treatment for NOWS between September 2020 and March 2022. Data were analyzed from November 2022 to January 2024. Exposure: Opioid treatment for NOWS and the ESC care approach. Main Outcomes and Measures: For each outcome (total opioid exposure, peak opioid dose, time from birth to initiation of first opioid dose, length of opioid treatment, and LOS), we used generalized linear mixed models to adjust for the stepped-wedge design and maternal and infant characteristics. Results: In the ESC-NOW trial, 463 of 1305 infants were pharmacologically treated (143/603 [23.7%] in the ESC care approach group and 320/702 [45.6%] in the usual care group). Mean total opioid exposure was lower in the ESC care approach group with an absolute difference of 4.1 morphine milligram equivalents per kilogram (MME/kg) (95% CI, 1.3-7.0) when compared with usual care (4.8 MME/kg vs 8.9 MME/kg, respectively; P = .001). Mean time from birth to initiation of pharmacologic treatment was 22.4 hours (95% CI, 7.1-37.7) longer with the ESC care approach vs usual care (75.4 vs 53.0 hours, respectively; P = .002). No significant difference in mean peak opioid dose was observed between groups (ESC care approach, 0.147 MME/kg, vs usual care, 0.126 MME/kg). The mean length of treatment was 6.3 days shorter (95% CI, 3.0-9.6) in the ESC care approach group vs usual care group (11.8 vs 18.1 days, respectively; P < .001), and mean LOS was 6.2 days shorter (95% CI, 3.0-9.4) with the ESC care approach than with usual care (16.7 vs 22.9 days, respectively; P < .001). Conclusion and Relevance: When compared with usual care, the ESC care approach was associated with less opioid exposure and shorter LOS for infants pharmacologically treated for NOWS. The ESC care approach was not associated with a higher peak opioid dose, although pharmacologic treatment was typically initiated later. Trial Registration: ClinicalTrials.gov Identifier: NCT04057820.


Assuntos
Analgésicos Opioides , Síndrome de Abstinência Neonatal , Humanos , Síndrome de Abstinência Neonatal/tratamento farmacológico , Feminino , Recém-Nascido , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Masculino , Tempo de Internação/estatística & dados numéricos , Sono/efeitos dos fármacos
15.
BMC Pregnancy Childbirth ; 24(1): 242, 2024 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38580935

RESUMO

BACKGROUND: Infants who are born from mothers with substance use disorder might suffer from neonatal abstinence syndrome (NAS) and need treatment with medicines. One of these medicines is phenobarbital, which may cause side effects in long-term consumption. Alternative drugs can be used to reduce these side effects. This study seeks the comparison of the effects of phenobarbital & levetiracetam as adjuvant therapy in neonatal abstinence syndrome. METHODS: This randomized clinical trial was performed in one year from May 2021 until May 2022. The neonates who were born from mothers with substance use disorder and had neonatal abstinence syndrome in Afzalipoor Hospital of Kerman were studied. The treatment started with morphine initially and every four hours the infants were checked. The infants who were diagnosed with uncontrolled symptoms After obtaining informed consent from the parents were randomly divided into two groups and treated with secondary drugs, either phenobarbital or levetiracetam. RESULTS: Based on the obtained results, it was clear that there was no significant difference between the hospitalization time of the two infant groups under therapy (phenobarbital: 18.59 days versus Levetiracetam 18.24 days) (P-value = 0.512). Also, there was no significant difference between both groups in terms of the frequency of re-hospitalization during the first week after discharge, the occurrence of complications, and third treatment line prescription (P-value = 0.644). CONCLUSIONS: Based on the obtained results, like hospitalization duration time (P-value = 0.512) it seems that levetiracetam can be used to substitute phenobarbital in treating neonatal abstinence syndrome. TRIAL REGISTRATION: The current study has been registered in the Iran registry of clinical trials website (fa.irct.ir) on the date 25/2/2022 with registration no. IRCT20211218053444N2.


Assuntos
Síndrome de Abstinência Neonatal , Extratos Vegetais , Transtornos Relacionados ao Uso de Substâncias , Recém-Nascido , Lactente , Feminino , Humanos , Síndrome de Abstinência Neonatal/tratamento farmacológico , Síndrome de Abstinência Neonatal/diagnóstico , Levetiracetam/uso terapêutico , Unidades de Terapia Intensiva Neonatal , Fenobarbital/uso terapêutico , Hospitalização
16.
P R Health Sci J ; 43(1): 25-31, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38512758

RESUMO

OBJECTIVE: Neonatal abstinence syndrome (NAS) is a set of drug withdrawal symptoms suffered by neonates exposed to drugs in utero. Several studies have widely described NAS incidence and treatment approach; however, little is known regarding the incidence and manifestations of this disease in Puerto Rico (PR). The principal aim of this study was to describe NAS incidence in the neonatal units of hospitals affiliated with the University of PR in terms of occurrence, clinical manifestations, and treatment approaches. METHODS: Our study evaluated the medical records of NAS babies diagnosed from 2018 through 2020 at 2 hospitals affiliated with the University of PR Medical Sciences Campus. Descriptive and inferential statistics were employed to analyze trends. RESULTS: We identified 12 neonates diagnosed with NAS, 5 with low birthweights (<2500 g); for a NAS incidence of 2 cases per 1000 admitted for the 3 years of recollected data. The urine toxicology results revealed that 9 had experienced intrauterine polydrug exposure. Phenobarbital loading dose were determined on the day of diagnosis (indicated by Finnegan score). The first manifestation of NAS symptoms varied: 8 neonates showed symptoms within 48 hours after birth, whereas 4 had withdrawal symptoms within 72-120 hours of their births. Differences between dosing practices and guidelines were observed, ranging from a 0.69% to a 25% difference during treatment initiation. CONCLUSION: Further research on the incidence of NAS in PR (national level) is needed for a deeper understanding that we hope will lead to the development of enhanced treatment protocols in PR.


Assuntos
Metadona , Síndrome de Abstinência Neonatal , Recém-Nascido , Humanos , Metadona/uso terapêutico , Síndrome de Abstinência Neonatal/tratamento farmacológico , Síndrome de Abstinência Neonatal/epidemiologia , Síndrome de Abstinência Neonatal/diagnóstico , Porto Rico/epidemiologia , Unidades de Terapia Intensiva Neonatal , Universidades , Analgésicos Opioides/uso terapêutico
17.
JAMA Netw Open ; 7(3): e241651, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38457184

RESUMO

This cross-sectional study examines COVID-19 pandemic­related changes in rates of neonatal abstinence syndrome (NAS) and whether infants in urban or rural areas and those with low socioeconomic status were disproportionately affected.


Assuntos
COVID-19 , Síndrome de Abstinência Neonatal , Transtornos Relacionados ao Uso de Opioides , Recém-Nascido , Humanos , Síndrome de Abstinência Neonatal/epidemiologia , Síndrome de Abstinência Neonatal/tratamento farmacológico , Pandemias , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologia
18.
Biol Res Nurs ; 26(3): 460-468, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38528812

RESUMO

Problem: Neonatal abstinence syndrome (NAS) affecting neonates with fetal exposure to opioids, is defined by expression and severity of symptoms. The pathophysiology behind symptoms variability is lacking. The study aims were to examine (a) differences in gut microbiota of neonates with and without NAS, (b) the relationships between gut microbiota and symptom expression and NAS severity, and (c) the changes in the neonate gut microbiota diversity during the course of NAS treatment. Methods: A cross-sectional observational design was used to examine differences in microbiota and a longitudinal, repeated measures approach was used to determine relationships between gut microbiota and NAS symptoms. Symptom data were collected using the Finnegan Neonatal Abstinence Scoring Tool and the Neonatal Pain Agitation and Sedation Scale. Stool samples were collected for microbiome analyses with 16S rRNA microbiome sequencing. Results: Differences in alpha and beta diversity between neonates with and without NAS were seen. Relative abundance results revealed 18 taxa were different in neonates with NAS compared to neonates without NAS. No differences were found in alpha or beta diversity in neonates with NAS between enrollment and hospital discharge. There was increased abundance of Escherichia-Shigella and Bacteriodes genera related to higher symptom scores. Discussion: Differences in alpha and beta diversity between neonates with and without NAS may be due to differences in birth mode and type of feeding. The findings of specific increased bacteria related to increased symptoms in the neonates with NAS may also be influenced by birth mode and type of feeding.


Assuntos
Microbioma Gastrointestinal , Síndrome de Abstinência Neonatal , Humanos , Síndrome de Abstinência Neonatal/microbiologia , Recém-Nascido , Feminino , Estudos Transversais , Masculino , Índice de Gravidade de Doença , Fezes/microbiologia , RNA Ribossômico 16S , Estudos Longitudinais
19.
JAMA Netw Open ; 7(2): e240295, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38407906

RESUMO

Importance: Neonatal abstinence syndrome (NAS) is a medical condition among neonates experiencing substance withdrawal due to the mother's substance use during pregnancy. While previous studies suggest that the overall incidence and annual costs of NAS are increasing, to date, the long-term costs have yet to be demonstrated in Medicaid populations. Objective: To examine the demographic differences and long-term costs of care for neonates diagnosed with vs not diagnosed with NAS. Design, Setting, and Participants: This cohort study used claims data from the Alabama Medicaid Agency for neonates born to Medicaid-eligible mothers between January 1, 2010, and December 31, 2020. Data were analyzed in June 2022. Exposure: A diagnosis of NAS within 30 days of birth. Main Outcomes and Measures: Rate of NAS by demographic and birth characteristics, long-term costs attributable to NAS status and demographic and birth characteristics, and distribution of this expenditure over the enrollment period. Results: A total of 346 259 neonates with Medicaid eligibility were born during the study period (mean [SD] gestational age, 38.4 [2.2] weeks; 50.5%, male), 4027 (1.2%) of whom had an NAS diagnosis within 30 days of birth. A larger percentage of neonates with an NAS diagnosis were male (52.7%) than in the group without NAS (50.5%). Neonates with NAS also weighed less at birth (mean difference, -212.0 g; 95% CI, -231.1 to -192.8 g) and had older mothers (mean difference, 3.4 years; 95% CI, 2.6-4.2 years). An NAS diagnosis had an estimated additional cost of $17 921 (95% CI, $14 830-$21 012) over the enrollment period, and this cost was not evenly distributed over that period. Conclusions and Relevance: In this cohort study of neonates born into the Alabama Medicaid population, those with an NAS diagnosis had a different demographic profile and a higher cost to state Medicaid agencies than those without NAS. These findings warrant further effort to reduce the occurrence of NAS.


Assuntos
Síndrome de Abstinência Neonatal , Síndrome de Abstinência a Substâncias , Recém-Nascido , Estados Unidos/epidemiologia , Feminino , Gravidez , Humanos , Masculino , Adulto , Síndrome de Abstinência Neonatal/epidemiologia , Síndrome de Abstinência Neonatal/terapia , Estudos de Coortes , Medicaid , Alabama/epidemiologia
20.
J Addict Med ; 18(3): 288-292, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38354121

RESUMO

OBJECTIVE: There is a lack of knowledge about the relative safety and efficacy of naltrexone for the treatment of pregnant individuals with opioid and/or alcohol use disorder, including the range of outcomes, in both the pregnant individual and the infant, over the course of peripartum period. Our objective was to describe these outcomes in a cohort of pregnant individuals on naltrexone. METHODS: In this prospective case series, 7 pregnant individuals with opioid use disorder (OUD) or alcohol use disorder (AUD) treated with naltrexone were followed from pregnancy through 12 months after delivery. Clinical treatment protocols and outcomes related to safety and efficacy during pregnancy, delivery, and the postpartum period are described. RESULTS: There were 4 pregnant individuals with OUD and 3 with AUD, of which 3 were managed with oral and 4 with extended-release naltrexone. The mean gestational age at study enrollment was 21.7 (SD, 12) weeks. Of the 7 participants, there was no return to nonprescribed opioid use and 2 who experienced a return to alcohol use over the course of the study. All individuals delivered vaginally at a mean of 37 weeks gestation without any peripartum pain difficulties. Five of the individuals (71.4%) remained on naltrexone 12 months after delivery. There were no reported fetal anomalies and one preterm delivery. None of the infants developed neonatal opioid withdrawal syndrome. CONCLUSIONS: For pregnant individuals with OUD or AUD treated with naltrexone, there were low rates of return to nonprescribed use and reassuring pregnant person and infant outcomes to 12 months postpartum.


Assuntos
Alcoolismo , Naltrexona , Antagonistas de Entorpecentes , Transtornos Relacionados ao Uso de Opioides , Complicações na Gravidez , Humanos , Feminino , Naltrexona/uso terapêutico , Naltrexona/administração & dosagem , Gravidez , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Adulto , Complicações na Gravidez/tratamento farmacológico , Antagonistas de Entorpecentes/uso terapêutico , Antagonistas de Entorpecentes/administração & dosagem , Estudos Prospectivos , Alcoolismo/tratamento farmacológico , Recém-Nascido , Adulto Jovem , Resultado da Gravidez , Síndrome de Abstinência Neonatal/tratamento farmacológico
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