Klin Padiatr 2013; 225(05): 247-251
DOI: 10.1055/s-0033-1347190
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Neonatal Opiate Withdrawal and Rooming-In: A Retrospective Analysis of a Single Center Experience

Neonataler Opiatentzug und Rooming-in: Retrospektive Analyse der Erfahrungen eines Zentrums
C. Hünseler
1   Neonatology, Children’s Hospital of the University of Cologne, Germany
,
M. Brückle
1   Neonatology, Children’s Hospital of the University of Cologne, Germany
,
B. Roth
1   Neonatology, Children’s Hospital of the University of Cologne, Germany
,
A. Kribs
1   Neonatology, Children’s Hospital of the University of Cologne, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
21 August 2013 (online)

Abstract

Aims:

To evaluate our treatment of neonatal abstinence syndrome (NAS), our experience with rooming-in of opiate-dependent mothers and to examine the influence of rooming-in on short term outcome of infants exposed to opiates in utero.

Method:

Retrospective analysis of maternal and perinatal data of newborn infants with NAS treated between 2004 and 2011 in a level 3 academic children’s hospital in a German metropolis. Therapy of NAS and duration of therapy, length of hospital stay and costs were considered in particular.

Findings:

Data of 77 newborns with NAS were analysed. 84.6% of infants were treated with tincture of opium (79.2% rooming-in, 88.7% no rooming-in). Infants with rooming-in (n=24) had a 17% shorter median duration of therapy [27.0 d (IQR 24.0–38.5), no rooming-in (n=53) 32.5 d (IQR 25.0–54.5)] and shorter median length of hospital stay [33.0 d (IQR 28.0–48.0), no rooming-in 41.5 d (IQR 30.3–54.5)]. Demographic data was comparable between newborns and mothers with or without rooming-in. Costs were median 13 457 € (IQR 8 967–17 494)/patient [rooming-in: 9 547 € (IQR 7 024–16 135), no rooming-in: 14 486 € (IQR 9 479–19 352)].

Conclusion:

Rooming-in in NAS should be encouraged to shorten duration of therapy and length of hospital stay and thereby reduce costs. No major problems arose in the care of the infants with NAS when parents stayed with their infants but close monitoring of the newborn and strict instruction of parents are required.

Zusammenfassung

Ziel der Studie:

Das neonatale Abstinenz-Syndrom (NAS) soll unter Berücksichtigung des Rooming-in unter Berücksichtigung gesund­heitsökonomischer Aspekte evaluiert werden.

Methode:

Retrospektive Analyse der maternalen und perinatalen Daten der von 2004 – 2011 in der Kinderklinik der Uniklinik Köln behandelten Kinder mit NAS. Berücksichtigt wurden Thera­pie des NAS, Dauer der Therapie, Verweildauer im Krankenhaus und Kosten.

Ergebnisse:

Es wurden die Daten von 77 Neugeborenen mit NAS durch mütterlichen Opiat­konsum ausgewertet, von denen 65 mit Opiumtinktur behandelt wurden. Kinder mit Rooming-in (n = 24) hatten eine um 17 % kürzere Therapiedauer als die Kinder ohne Rooming-in (n = 53) [27,0 d (IQR 24,0–38,5) vs. 32,5 d (IQR 25,0–54,5)] sowie eine kürzere mediane Verweildauer im Krankenhaus [33,0 d (IQR 28,0–48,0) vs. 41,5 d (IQR 30,3–54,5)]. Die demografischen Daten zwischen beiden Gruppen waren vergleichbar. Die medianen Behandlungskosten für ein Kind mit NAS betrugen 13 457 € (IQR 8 967–17 494)/Patient [mit Rooming-in: 9 547 € (IQR 7 024–16 135), ohne Rooming-in: 14 486 € (IQR 9 479–19 352)].

Schlussfolgerung:

Rooming-in bei Kindern mit NAS ist möglich und kann die Therapiedauer, die Verweildauer im Krankenhaus und die Kosten verringern. Es entstanden keine größeren Probleme in der Versorgung der Kinder, wenn die Pflege hauptsächlich durch die Eltern erfolgte, allerdings ist eine engmaschige Überwachung der Kinder und die Anleitung der Eltern erforderlich.

 
  • References

  • 1 Abrahams RR, Kelly SA, Payne S et al. Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Can Fam Physician 2007; 53: 1722-1730
  • 2 Agthe AG, Kim GR, Mathias KB et al. Clonidine as an adjunct therapy to opioids for neonatal abstinence syndrome: a randomized, controlled trial. Pediatrics 2009; 123: 849-856
  • 3 Almario CV, Seligman NS, Dysart KC et al. Risk factors for preterm birth among opiate-addicted gravid women in a methadone treatment program. Am J Obstet Gynecol 2009; 326: 1-6
  • 4 American Academy of Pediatrics Committee on Drugs. Neonatal drug withdrawal. Pediatrics 1998; 101: 1079-1088
  • 5 Autret F, Mucignat V, De Montgolfier-Aubron I et al. Use of diazepam in the treatment of opioid neonatal abstinence syndrome. Arch Pediatr 2004; 11: 1308-1313
  • 6 Bandstra ES, Morrow CE, Mansoor E et al. Prenatal drug exposure: infant and toddler outcomes. J Addict Dis 2010; 29: 245-258
  • 7 Bläser A, Pulzer F, Knüpfer M et al. Drug withdrawal in newborns – clinical data of 49 infants with intrauterine drug exposure: what should be done?. Klin Padiatr 2008; 220: 308-315
  • 8 Cleary BJ, Donnelly JM, Strawbridge JD et al. Methadone and perinatal outcomes: a retrospective cohort study. Am J Obstet Gynecol 2011; 139: e1-e9
  • 9 Cleary BJ, Donnelly J, Strawbridge J et al. Methadone dose and neonatal abstinence syndrome – systematic review and meta-analysis. Addiction 2010; 105: 2071-2084
  • 10 Coyle MG, Ferguson A, Lagasse L et al. Diluted tincture of opium (DTO) and phenobarbitone versus DTO alone for neonatal opiate withdrawal in term infants. J Pediatr 2002; 140: 561-564
  • 11 Doberczak TM, Kandall SR, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr 1991; 118: 933-937
  • 12 Dysart K, Hsieh HC, Kaltenbach K et al. Sequela of preterm versus term infants born to mothers on a methadone maintenance program: differential course of neonatal abstinence syndrome. J Perinat Med 2007; 35: 344-346
  • 13 Finnegan LP, Connaughton JF, Kron RE et al. Neonatal abstinence syndrome: assessment and management. Addict Dis 1975; 2: 141-158
  • 14 Goel N, Beasley D, Rajkumar V et al. Perinatal outcome of illicit substance use in pregnancy – comparative and contemporary socio-clinical profile in the UK. Eur J Pediatr 2011; 170: 199-205
  • 15 Heimann K, Bartz C, Silvestri A et al. Methadone Substitution during Pregnancy: Relationship between Dose and Effect in Neonatal Abstinence Syndrome. Geburtsh Frauenheilk 2006; 66: 277-283
  • 16 Hüning BM, Reimann M, Beerenberg U et al. Establishment of a family-centred care programme with follow-up home visits: implications for clinical care and economic characteristics. Klin Padiatr 2012; 224: 431-436
  • 17 Johnson K, Gerada C, Greenough A. Treatment of neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed 2003; 88: F2-F5
  • 18 Kaltenbach K, Finnegan LP. Neonatal abstinence syndrome, pharmacotherapy and developmental outcome. Neurobehav Toxicol Teratol 1986; 8: 353-355
  • 19 Kraft WK, van den Anker JN. Pharmacologic management of the opioid neonatal abstinence syndrome. Pediatr Clin North Am 2012; 59: 1147-1165
  • 20 Kraft WK, Dysart K, Greenspan JS et al. Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome. Addiction 2011; 106: 574-580
  • 21 Lam SK, To WK, Duthie SJ et al. Narcotic addiction in pregnancy with adverse maternal and perinatal outcome. Aust N Z J Obstet Gynaecol 1992; 32: 216-221
  • 22 Langenfeld S, Birkenfeld L, Herkenrath P et al. Therapy of the neonatal abstinence syndrome with tincture of opium or morphine drops. Drug Alcohol Depend 2005; 77: 31-36
  • 23 Lejeune C, Simmat-Durand L, Gourarier L et al. Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenophine substitution. Drug Alcohol Depend 2006; 82: 250-257
  • 24 Lim S, Prasad MR, Samuels P et al. High-dose methadone in pregnant women and its effect on duration of neonatal abstinence syndrome. Am J Obstet Gynecol 2009; 200: 70 e1-70 e5
  • 25 Loepke AW. Developmental neurotoxicity of sedatives and anesthetics: a concern for neonatal and pediatric critical care medicine?. Pediatr Crit Care Med 2010; 11: 217-226
  • 26 McLemore GL, Lewis T, Jones CH et al. Novel pharmacotherapeutic strategies for treatment of opioid-induced neonatal abstinence syndrome. Semin Fetal Neonatal Med 2013; 18: 35-41
  • 27 Müller MJ, Lange M, Paul T et al. Breast feeding during methadon- and buprenorphin therapy. Klin Padiatr 2011; 223: 408-413
  • 28 Osborn DA, Jeffery HE, Cole MJ. Sedatives for opiate withdrawal in newborn infants. Cochrane Database Syst Rev 2010; CD002053
  • 29 Osborn DA, Jeffery HE, Cole M. Opiate treatment for opiate withdrawal in newborn infants. Cochrane Database Syst Rev 2005; CD002059
  • 30 Rohrmeister K, Bernert G, Langer M et al. Opiate addiction in gravidity – consequences for the newborn. Results of an interdisciplinary treatment concept. Z Geburtshilfe Neonatol 2001; 205: 224-230
  • 31 Saiki T, Lee S, Hannam S et al. Neonatal abstinence syndrome – postnatal ward versus neonatal unit management. Eur J Pediatr 2010; 169: 95-98
  • 32 Sarkar S, Donn SM. Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey. J Perinatol 2006; 26: 15-17
  • 33 Seligman NS, Almario CV, Hayes EJ et al. Relationship between maternal methadone dose at delivery and neonatal abstinence syndrome. J Pediatr 2010; 157: 428-433