Neonatal Abstinence Syndrome
Courty et al. 2012
9/21/2013
FT, Review. Says that buprenorphine is first choice and that KC can lessen
withdrawal. Breast-feeding should be encouraged. It does not treat or cure NAS
but allows a skin-to-skin contact that could lessens an occurring withdrawal.
igh? Highty? I have seen a new reference on KC and NAS by something like this as of April 15, so I will
find it and add it after doing two RO1 grants due May 1. 2013
Kieviet et al., 2013
FT,PT, infants can withdraw from SSRIs and it is called Poor Neonatal Adaptation
and KC is a supportive therapy for this type of withdrawal.
Ludington-Hoe, 2013 FT, case descriptive report of two babies who had lower Finnegan scores while
in KC over several days. KC was done for 8-11hours at night by moms.
Pritham, 2013
Review of how to help substance abusing mothers BF their NAS babies and it
says that KC helps with BF. The full article may say more, but I don’t have the
full article yet
Researchers:
4/20/2013
Lauren Thorngate, Ph.D., RN, CCRN. Post doctoralfellow at University of Washington.
Wants to study NAS and outcome on sleep, perhaps using the aEEG method rather than basic EEG.
Contact Laurent3@u.washington.edu or her advisor Shuyuann Wang Foreman whose email is
yuann@u.washington.edu
4/24/2013 Kathleen Allen,NNP at St. Elizabeth Hospital in Edgewood KY who is looking at KC and
infant self regulation and severity of abstinence syndrome. Email is Kathleen.allen@stelizabeth.com
Related Literature
Several questions need to be asked before KC becomes standard therapy for NAS:
1. Is KC safe and efficacious for treating NAS in the presence of maternal polysubstance abuse?
2. Is KC safe and efficacious in preterm infants?
3.How should duration of KC be adjusted when scores begin to rise during weaning?
4. Is KC useful I preventing and treating withdrawal associate with iatrogenic physiologic opioid
tolerance in infants receiving narcotics for pain management?
4. What will randomized controlled trials of KC show?
5. How does KC help the mothers?
Bell, S.G., (2012). Buprenorphine: A newer drug for treating neonatal abstinence syndrome. Neonatal
Network, 31(3), 178-182. Buprenorphine pharmokinetics have appeared in only article (1993) . Opioid
receptors are molecules on the surface of cells in which opioid compounds attach and exert their
effects. There are several opioid receptors in the brain, but the most relevant one to opiod use and
abuse is the mu (µ) receptor. Opioid agonist (agonist =activator) is an opiate that binds to a receptor
site in the brain and turns it on to produce an effect in the organism. Increasing the dose of the agonist
increases the effects luntil a maximum effect is reached or until the receptor is fully activated.
Morphine, methoadone, heroin, oxycodone and hydrocodone are full opioid agents. Opioid antagonist
is a substance that binds with the receptor site to block activation by preventing the attachment of an
agonist to the receptor. Narcan is an antagonist. Partial opioid agonist. This is an opioid with some of
the properties of both an agonist and an antagonist. They bind to receptors and activate them butnot to
the same degree as a full agonist. At lower doses, agonist and partial agonists produce the same effects;
with increasing doses of a partial agonist, there is an increasing effect but only up to a point. At this
point, increased doses do not produced increased effects. This is the ceiling effect. Additionally, partial
opioid agonist displace or block full agonist from the receptors. Buprenorphine is a partial opioid
agonist.
KC produces oxytocin whichis a partial opiod agonist, but one that seems to be able to induce a dense
signal generation at the mu opioid receptor, similar to morphine but higher doses of buprenorphine
may be able to do the same as morphine, but buprenorphine does has to exceed 39 mg/kg/day (Kraft,
WK, Dysart K, Greenspac JS, Gibson E,Kaltenbach K, Ehrlich ME. 2011. Revised dose schema of
sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome Addiction,
106(3), 581-582. Doi: 10.1111/j.1360-0443.2010.03236.x.
If medicines don’t work, infant can have seizures. Then we should try KC.
Seizures may be due to subdural hematomas in the posterior fossa due to delivery process, but should
look for parenchymal abnormalities.
ANOTHER BUPRENORPHINE source: National alliance of advocates for Buprenorphine treatment.
Thorough technical explanation of buprenorphine. Available at
http://www.naabt.org/education/technical_explanation-buprenorphine.cfm. Accessed 11/18/2011.
Substance Abuse and Mental Health Services Administration. (2011). Results from the 2010 National
Survey in Drug Use and Health, Summary of National FINDINGS. Rockville, MD: Substance Abuse and
Mental Health Administration. NSDUH Series H-41, HHS Publication No (SMA) 11-4658. NAS is serious
health problem. 4.4% of pregnant women between the ages of 15 and 44 years used illicit drugs. The
rate is highest among the youngest group (15.8% or 14,000 in 15-17 year olds); the rate for 18-25 year
olds is 7.4% and 1.9 % for 26-44 year olds (NI on Drug Abuse, 2011. Topics in brief- prenatal exposure to
drugs of abuse-May 2011. Availabel at http://drugabuse.gov/sites/default/files/prenatal.pdf)
Assessing and managing NAS is labor intensive and fiscally costly. It is essential that researchcontinue
to focus on effective means of assessing and managing NAS with the goal of safely decreasing both the
lengths of treatment and the lengths of hospitalization for these infants.