Neonatal Abstinence: The epidemic Its Impact on All of Us
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1 Neonatal Abstinence: The epidemic Its Impact on All of Us Michelle Bode MD, MPH Neonatologist Crouse Hospital Assistant Professor Pediatrics SUNY Upstate
2 Objectives & Disclosure Statement 1) The participant will be able to define the role of maternal opioid use and the risk of neonatal abstinence 2) The participant will be able to define neonatal abstinence and its impact on maternal newborn bonding 3) The participant will understand the magnitude of NAS epidemic in central NY and the US. Dr. Michelle Bode has no conflicts of interest or financial relationships with any commercial entities.
3 PREGNANCY AND PRESCRIPTION OPIOID ABUSE AMONG SUBSTANCE ABUSE TREATMENT ADMISSIONS Martin, C.E., et al. Recents trends in treatment admissions for prescription opioid abuse during pregnancy. Journal of Substance Abuse Treatment
4 For the Mom To Be Referral to treatment programs needs to be expedited Data is conflicting as to BEST Evidence for MOM management Should we DETOX during pregnancy Should we recommend MAINTENANCE therapy Is Naloxone safe in pregnancy? Care & Treatment needs to look at the DYAD THE MAGIC WINDOW OF OPPORTUNITY
5 NEONATAL ABSTINENCE SYNDROME A constellation of typical signs and symptoms that occur in infants that have been exposed in utero, therefore have developed dependence, to certain illicit or prescription medications
6 NAS NATIONWIDE
7 NAS NATIONWIDE INCIDENCE Tolia VN, et al. Increasing Incidence of the Neonatal Abstinence Syndrome in US Neonatal ICU s. NEJM Pediatrix Database Year Incidence 7/ /1000
8 THE CNY EXPERIENCE- BIRTH CERTIFICATE DATA Total Live Births 500 grams Illicit Drug Use during pregnancy 2.1% (403) 2.5% (496) 3.2% (600) 3.5% (669) 4.7% (889) 5.3% (967) 5.9% (1074)
9 INCIDENCE CNY Birth Not Born at Crouse Born at Crouse Incidence (exposed /1000 livebirths) % 4.5% % 6.4% % 7.7% % 8.1% 59
10 MANAGEMENT Prenatal Consult with Neonatology Breastfeed when possible --Dispel the myth that only formula is safe now Comfort Measures- Infant Massage Swaddling Quiet environment Family Involvement Monitoring with a standard protocol Treatment with medications
11 BREASTFEEDING
12 NEONATAL PHARMACOLOGIC TREATMENTS: Morphine Methadone Buprenorphrine Clonidine Phenobarbital WHAT s BEST????
13 Infant Outcomes: Short and Long Term Increased risk of poor bonding, poor infant growth Higher risk of infant death SIDS Rollover accidents Poisoning HOWEVER Development can be normal when the infant is raised in an enriched and loving environment
14 ONONDAGA COUNTY RESPONSE Drug Task force- members include: Health Commisioner Medical Community- Representatives from all Hospitals and Community providers Law Enforcement Community Leaders GOALS: Training of Healthcare staff to identify women and deliver early treatment Develop Public Health Campaign Eliminate access and availability of illicit drugs
15 REFERENCES 1. American Academy of Pediatrics. Neonatal Drug Withdrawal. Committee on Drugs. Pediatrics. Feb American Academy of Pediatrics. Neonatal Drug Withdrawal. Committee on Drugs. Pediatrics. 1998;101: Burgos AE, Burke BL. Neonatal abstinence syndrome. Neoreviews. May 2009;10(5): e222-e Sielski LA. Neonatal opioid withdrawal. UpToDate.Jan 22,09; Osborn DA, Jeffery HE, Cole MJ. Opiate treatment for opiate withdrawal in newborn infants. Cochrane Database of Systemic Reviews. 2009, Issue Osborn DA, Jeffery HE, Cole MJ. Sedatives for opiate withdrawal in newborn infants. Cochrane Database of Systemic Reviews. 2009, Issue Johnson K, Gerada C, Greenough A. Treatment of neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed. 2003;88:F2-F5. 8. Coyle MG, Ferguson A, et al. Diluted tincture of opium (DTO) and Phenobarbital versus DTO alone for neonatal opiate withdrawal. J Pediatr. 2002;140: Finnegan LP, Connaughton JF Jr, Kron RE, Emich JP. Neonatal abstinence syndrome: assessment and management. Addict Dis.1975;2: Medications and mothers milk. HalePublishing Bio LL, Siu A, Poon CY. Update on the pharmacologic management of neonatal abstinence syndrome. J Perinatalogy. 2011;116: Pritham UA. Breastfeeding promotion for management of neonatal abstinence syndrome. JOGGN. 2013;42: Wexelblatt SL, Ward LP, Torok K, et al. Universal maternal drug testing in a high prevalence region of prescription opiate abuse. J Peds. March 2015;166(3): Tolia VN, Patrick SW, Bennett MM, et al. Increasing incidence of the neonatal abstinence syndrome in US neonatal ICUs. NEJM. April 2015; downloaded from the nejm.org on May 16, 2015.
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