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Care-by-parent model as a tool for reduction in neonatal opioid withdrawal syndrome in neonates exposed to buprenorphine maintenance therapy in-utero.

Lawlor ML, Shook L, McQuerry K, Srinivasan A, Johnson QB, Chavan NR, Critchfield AS.

J Matern Fetal Neonatal Med. 2018 Dec 18:1-111. doi: 10.1080/14767058.2018.1558201.



USA. MATER Center Director, on the Importance of Dr. Finnegan’s Work—Which Continues—and the Need to Treat Mothers for Trauma

Loretta Finnegan, MD, a champion of medication-assisted treatment with methadone, developed her scoring system for newborns more than 40 years ago. The Finnegan Neonatal Abstinence Scoring System (FNASS) assigns a numerical score to 21 clinical signs, and babies are treated accordingly. Developing the test was an important step in making sure that these babies were treated with morphine, if necessary, to manage the symptoms of withdrawal.

But the work of Dr. Finnegan goes far beyond the Finnegan score. When she first started an opioid treatment program (OTP) at Thomas Jefferson University in Philadelphia, 44 years ago, Dr. Finnegan opened a landmark program for pregnant women addicted to opioids. Since then, the program, called Maternal Addiction Treatment Education & Research (MATER), has included intensive outpatient treatment as well as residential treatment.

Diane Abatemarco, PhD, MSW, director of MATER and associate professor of OB/GYN and Pediatrics at the Sidney Kimmel Medical College at Jefferson, talked with AT Forum about the scope and importance of Dr. Finnegan’s work. (ATForum, USA, 17.12.2019)


USA. Healthy Pregnancy Healthy Baby Fact Sheets

This series of four fact sheets emphasizes the importance of continuing a mother's treatment for opioid use disorder (OUD) throughout pregnancy. The series includes information on OUD and pregnancy, OUD treatment, neonatal abstinence syndrome, and considerations to address before hospital discharge. (SAMSHA - Substance Abuse and Mental Health Services Administration, USA, August 2018)


Growth during the first year in infants affected by neonatal abstinence syndrome.

Corr TE, Schaefer EW, Paul IM.

BMC Pediatr. 2018 Nov 5;18(1):343. doi: 10.1186/s12887-018-1327-0.


The Impact of Breastfeeding on Health Outcomes for Infants Diagnosed with Neonatal Abstinence Syndrome: A Review.

Wu D, Carre C.

Cureus. 2018 Jul 28;10(7):e3061. doi: 10.7759/cureus.3061. Review.


Novel Withdrawal Symptoms of a Neonate Prenatally Exposed to a Fentanyl Analog.

Nellhaus EM, Murray S, Hansen Z, Loudin S, Davies TH.

J Pediatr Health Care. 2018 Nov 8. pii: S0891-5245(18)30204-9. doi: 10.1016/j.pedhc.2018.08.014.



Impact of timing of methadone initiation on perinatal outcomes following delivery among pregnant women on methadone maintenance therapy in Ontario.

Guan, Q., Sproule, B. A., Vigod, S. N., Cadarette, S. M., Greaves, S., Martins, D., and Gomes, T. (2018) 

Addiction, doi.org/10.1111/add.14453.



Opium use during pregnancy and infant size at birth: a cohort study.

Maghsoudlou S, Cnattingius S, Montgomery S, Aarabi M, Semnani S, Wikström AK, Bahmanyar S.

BMC Pregnancy Childbirth. 2018 Oct 1;18(1):358. doi: 10.1186/s12884-018-1994-8.


Outcome Differences in Neonates Exposed In-Utero to Opioids Managed in the NICU Versus Pediatric Floor.

Lembeck AL, Tuttle D, Locke R, Lawler L, Jimenez P, Mackley A, Paul DA.

J Addict Med. 2018 Sep 24. doi: 10.1097/ADM.0000000000000455.



Persistent feeding difficulties among infants with fetal opioid exposure: mechanisms and clinical reasoning.

Brandon J. Hart, Sreekanth Viswanathan & Sudarshan R. Jadcherla (2018) 

The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2018.1469614 



Impact of psychiatric medication co-exposure on Neonatal Abstinence Syndrome severity.

Wachman EM, Warden AH, Thomas Z, Thomas-Lewis JA, Shrestha H, Nikita FNU, Shaw D, Saia K, Schiff DM.

Drug Alcohol Depend. 2018 Sep 1;192:45-50. doi: 10.1016/j.drugalcdep.2018.07.024. 



Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues.

Price HR, Collier AC, Wright TE.

Front Pharmacol. 2018 Aug 28;9:961. doi: 10.3389/fphar.2018.00961. eCollection 2018. Review.


Morphine vs Methadone Treatment for Infants with Neonatal Abstinence Syndrome.

Tolia VN, Murthy K, Bennett MM, Greenberg RG, Benjamin DK, Smith PB, Clark RH.

J Pediatr. 2018 Sep 14. pii: S0022-3476(18)30967-3. doi: 10.1016/j.jpeds.2018.07.061.



As the NAS Crisis Worsens, a New Study Offers Treatment Guidelines

The incidence of neonatal abstinence syndrome (NAS) has been climbing steadily, according to a 2016 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC). The report, published August 12, indicated that the number of NAS cases rose from 1.5 per 1,000 hospital births in 1999 to 6 per 1,000 in 2013.

Yet guidelines for treating NAS have been lacking, according to a study in JAMA Pediatrics. The study, published online June 18, found that although several different approaches are being used, “no universal evidence-based pharmacological treatment strategy exists.” The article also noted that the FDA hasn’t approved any drug for treating infants who have NAS.

The authors of the JAMA Pediatrics study said that, without clear treatment guidelines, caregivers have typically chosen either methadone or morphine to treat their young NAS patients.

New Guidelines

Which medication—methadone or morphine—is better, and how to decide on an appropriate dose? Some studies have suggested basing the dose on the infant’s weight; others, on the severity of NAS, as assessed by the Finnegan Neonatal Abstinence Scoring System.

The JAMA Pediatrics team set out to answer the medication questions. They designed a treatment plan, then carried out what they believe is the first multisite, double-blind, randomized trial comparing the safety and efficacy of methadone and morphine in NAS. They published their results online June 18. (atforum.com, USA, 04.09.2018)


Stabilizing the Mother-Infant Dyad for Better Outcomes from OB to FM: Caring for Patients with Perinatal Opioid Use Disorder through the 4th Trimester.

Ramage M, Ostrach B, Fagan B, Coulson CC.

N C Med J. 2018 May-Jun;79(3):164-165. doi: 10.18043/ncm.79.3.164. 


Heroin - Drugs and Lactation Database 

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-.

Last Revision: May 1, 2018.


Methadone - Drugs and Lactation Database.

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-.

Last Revision: June 4, 2018.


Buprenorphine - Drugs and Lactation Database

Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Last Revision: June 4, 2018.


Comparison of outcomes between morphine and concomitant morphine and clonidine treatments for neonatal abstinence syndrome.

Gullickson C, Kuhle S, Campbell-Yeo M.

Acta Paediatr. 2018 Jul 4. doi: 10.1111/apa.14491.



Drogenentzugssyndrom bei Babys nicht abrechnungsfähig

Celle – Tabak ist nach einem Urteil des Landessozialgerichts Niedersachsen-Bremen keine Droge, zumindest hinsichtlich des Krankenhausvergütungsrechts. Unabhängig davon, ob Tabak und Nikotin im allgemeinen Sprachgebrauch als Drogen aufgefasst werden oder nicht, werde Tabak im Gesundheitssystem nicht mit Opiaten, Methadon oder Heroin gleichgesetzt, urteilten die Celler Richter in einem heute veröffentlichten Urteil (Az.: L 16 KR 43/16). (aerzteblatt.de, 09.07.2018)


Does Maternal Buprenorphine Dose Affect Severity or Incidence of Neonatal Abstinence Syndrome?

Wong J, Saver B, Scanlan JM, Gianutsos LP, Bhakta Y, Walsh J, Plawman A, Sapienza D, Rudolf V.

J Addict Med. 2018 Jun 13. doi: 10.1097/ADM.0000000000000427.



Active Ear Acupuncture Points in Neonates: Initial Results in a New Research Field.

Stadler J, Raith W.

Med Acupunct. 2018 Jun 1;30(3):155-158. doi: 10.1089/acu.2018.1277.


Auricular Medicine in Neonatal Care.

Raith W.

Med Acupunct. 2018 Jun 1;30(3):138-140. doi: 10.1089/acu.2018.1299.


Comparison of Safety and Efficacy of Methadone vs Morphine for Treatment of Neonatal Abstinence SyndromeA Randomized Clinical Trial. 

Davis JM, Shenberger J, Terrin N, et al. 

JAMA Pediatr.Published online June 18, 2018. doi:10.1001/jamapediatrics.2018.1307



USA. There's No Such Thing as a Baby Opioid Addict

“They can be born dependent on a substance, but there is a difference between dependence and addiction.”

(...) The distinction matters for opioid-exposed babies for a number of reasons. One reason is that addiction can be managed, but it doesn't have a cure, says Robert Newman, president emeritus of Beth Israel Medical Center. That can lead some people to think that once babies are "addicted," they're addicted for life. The label can impact them from their earliest experiences. 

"It has enormous potential harm to the babies, as the baby grows up, and to the family because of the stigma of the term 'addict,'" Newman says. "If the baby applies to kindergarten and the parent is asked about health issues and the parent says, 'the baby was born addicted,' that's the kiss of death. A lot of parents don't want their child sitting next to an addict." (vice.com, USA, 08.11.2017)


USA. Stop labeling babies as 'born addicted' — it stigmatizes them and is inaccurate

(...) Saying that babies are born with addiction stigmatizes the very babies that Brown seeks to help. As Robert Newman, president emeritus of Beth Israel Medical Center, tells Tonic, the label can harm the babies and their families because of the stigma associated with the word "addict." Newman points out that, as a child grows, this label is “the kiss of death. A lot of parents don’t want their child sitting next to an addict.” (The Hill, USA, 19.06.2018)


USA. Non-pharmacologic approaches improve outcomes for infants with neonatal abstinence syndrome 

BOSTON--A quality improvement (QI) initiative at Boston Medical Center that focused on using non-pharmacologic approaches to care for infants with neonatal abstinence syndrome (NAS) yielded positive short-term outcomes for both the mothers and infants. The results, published in the Journal of Perinatology, showed a decrease in medication use, length of stay, and health care costs. (Boston Medical Center, 04.06.2018)


Analysis of the factors that influence the Finnegan Neonatal Abstinence Scoring System.

Gomez-Pomar E, Christian A, Devlin L, Ibonia KT, Concina VA, Bada H, Westgate PM.

J Perinatol. 2017 Jul;37(7):814-817. doi: 10.1038/jp.2017.40.



Outpatient pharmacologic weaning for neonatal abstinence syndrome: A systematic review.

Murphy-Oikonen, J., & McQueen, K. (2018). 

Primary Health Care Research & Development, 1-9. doi:10.1017/S1463423618000270



Outpatient Pharmacotherapy for Neonatal Abstinence Syndrome.

Maalouf FI, Cooper WO, Slaughter JC, Dudley J, Patrick SW.

J Pediatr. 2018 May 7. pii: S0022-3476(18)30420-7. doi: 10.1016/j.jpeds.2018.03.048.