Symptoms of opioid withdrawal ( Figure 1) typically appear shortly after birth, with the majority exhibited within the first 48 h to 72 h postdelivery. Approximately 50% to 75% of infants born to women on opioids will require treatment for opioid withdrawal symptoms. The presentation of withdrawal symptoms varies, depending on the type of maternal opioid used, the frequency, dose and timing of last exposure, gestational age, maternal metabolism and maternal use of other substances. Other associated health risks include infections (e.g., hepatitis B, hepatitis C, syphilis and HIV), insufficient maternal nutrition or access to antenatal care, as well as social risk factors, and should be screened for, determined and managed appropriately. Obtaining a comprehensive medication or illicit substance use history and a focused social history are recommended. The literature reports that opioid substitution therapy during pregnancy may lessen the use of other opioids and illicit drugs and improve prenatal care, including access to education, counselling and community supportive services. Methadone is often recommended for opioid-dependent pregnant women and some studies suggest buprenorphine as an alternative treatment. Pregnant women with an opioid dependence should be advised to continue or commence an opioid maintenance therapy program. Potential long-term outcomes of prenatal opiate exposure are difficult to predict due to multiple, interrelated variables of maternal-infant risk factors that are known to impact developmental outcomes in this cohort. NAS is a set of drug withdrawal symptoms that can affect the central nervous system (CNS), and the gastrointestinal and respiratory systems in the newborn. The most significant effects of maternal opioid dependence and prenatal fetal exposure are short-term complications, with NAS predominating. Fentanyl, methadone, normethadone, tramadol and meperidine are synthetic. Heroin, oxycodone, hydrocodone, hydromorphone and buprenorphine are semi-synthetic. Natural compounds include morphine and codeine. Opioid use during pregnancy, whether prescribed or illicit, can be associated with negative pregnancy and infant outcomes, including prematurity, low birth weight, increased risk of spontaneous abortion, sudden infant death syndrome and infant neurobehavioural abnormalities. The costs of hospitalization speak to the significant burden this problem places on the health of mothers, infants and families, along with hospital units, health care providers and other community resources. Recent reports indicate the number of infants requiring observation for withdrawal symptoms is increasing annually and that cases are generally under-reported. The average length of stay in acute care facilities for these infants was 15 days. A large percentage of these cases are attributed to opioid withdrawal. Keywords: Discharge planning Management NAS NPI Treatment strategies BACKGROUNDįor 2016–17, the Canadian Institute for Health Information reported that an estimated 0.51% of all infants born in Canada (approximately 1850/year, Quebec excluded) had Neonatal Abstinence Syndrome (NAS). This practice point focuses specifically on the effect(s) of opioid withdrawal and current management strategies in the care of infants born to mothers with opioid dependency. Infants are at high risk for experiencing symptoms of abstinence or withdrawal that may require assessment and treatment. Increased prenatal exposure to opioids reflects rising prescription opioid use as well as the presence of both illegal opiates and opioid-substitution therapies. The incidence of infant opioid withdrawal has grown rapidly in many countries, including Canada, in the last decade, presenting significant health and early brain development concerns. Updated by Thierry Lacaze-Masmonteil Fetus and Newborn Committee Thierry Lacaze-Masmonteil, Pat O’Flaherty Canadian Paediatric Society.
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