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Old 06-27-2011
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Question new born infant, withdrawal symptoms from opioid

What treatment of new born infant withdrawal symptoms from opioid , because his mother is drug abuser ??
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Old 06-27-2011
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methadone?
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Old 06-27-2011
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can't naloxone be used?
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Old 06-27-2011
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Quote:
Originally Posted by cool_atomic View Post
can't naloxone be used?
No... Naloxone causes withdrawal symptoms.. Cant be used
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Old 06-27-2011
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methdaone can cause seizures in neonates.
from kaplan peds:
SUBSTANCE ABUSE AND NEONATAL WITHDRAWAL
A 2-day-old infant is noticed to have coarse jitters and is very irritable with a highpitched
cry. A low-grade fever is reported, as well as diarrhea. Maternal history is
positive for heroin use.
Definition-Infants born to actively addicted mothers will undergo withdrawal from
whatever drug they were exposed to in utero.
Risk Factors/Etiology-Various drugs cross the placenta, with heroin and methadone
being the most frequently associated with withdrawal.
Presentation
- Timing of presentation depends on the drug, its half-life, and the last maternal dose.
Signs include hyperactivity, irritability, fever, diarrhea, tremors/jitters, high-pitched
crying, sneezing, restlessness, vomiting, nasal stuffiness, poor feeding, seizures, and
tachypnea.
- Heroin withdrawal usually presents within 48 hours after birth. Onset of symptoms
for methadone withdrawal usually is several weeks (2-6), and there is higher risk for
seizures. Phenobarbital withdrawal occurs at 1-2 weeks.
Diagnostic tests-A good history and the clinical presentation usually are sufficient to
make the diagnosis. Urine drug screening of the infant may be helpful.
Treatment-Treatment consists of use of narcotics, sedatives, and hypnotics, as well as
swaddling and reducing noxious stimulation.
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Old 06-27-2011
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so looks like the Tx is entirely non-specific (narcotics, sedatives, comforting the baby, etc..)
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Old 06-28-2011
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NONPHARMACOLOGIC TREATMENT

Supportive care
Adequate nutrition
IV fluid and electrolyte replacement as needed
Measures to minimize sensory stimulation (e.g., swaddling, temperature stability)
Breast milk intake might be associated with reduced severity of withdrawal symptoms.
Prone positioning of infant may reduce severity of syndrome but also associated with decreased caloric intake.
Use of nonoscillating waterbeds associated with decreased need for medication, but mechanical rocking beds appear to worsen withdrawal symptoms.

INDICATIONS FOR PHARMACOLOGIC THERAPY

Seizures, poor feeding, severe vomiting/diarrhea, sleeplessness, fever
High withdrawal severity score on scales developed to assess neurologic, GI, respiratory, and metabolic status
Treatment threshold determined by average severity score on three consecutive exams
Numerical thresholds for two most commonly used scoring systems, both employing 0- to 3-point scales to gauge individual signs of withdrawal (e.g., increased muscle tone, tremors, vomiting)
Modified Finnegan score >8
Lipsitz score >4
Movement quantified by motion detector (actigraph on infant leg) may predict need for pharmacologic intervention.

MEDICATIONS

Opioids (e.g., tincture of opium, morphine, or methadone) generally recommended as medications of choice, but
May result in increased duration of hospital stay
No studies have evaluated the rate at which withdrawal medication should be weaned, so rate is determined by clinical symptoms.
Sedatives (e.g., phenobarbitone, diazepam) generally not preferred as initial treatment
Compared with opioids, sedatives may be associated with longer duration of treatment and greater incidence of treatment failure, seizures, and nursery admission.
Addition of phenobarbitone to opium may reduce withdrawal severity, length of hospital stay, and maximum daily opium dose.
Naloxone (Narcan) and clonidine (Catapres) have limited data regarding efficacy and safety in infants.

http://www.clinicaladvisor.com/neona...rticle/136834/


pharmacological treatment of opiate withdrawal in neonates is deemed necessary, opiates are the treatment of choice, which are slowly tapered down to wean the neonate off opiates. Phenobarbitol is sometimes used as an alternative but is less effective in suppressing seizures; however, phenobarbitol is superior to diazepam for neonatal opiate withdrawal symptoms. In the case of sedative-hypnotic neonatal withdrawal, phenobarbitol is the treatment of choice

http://en.wikipedia.org/wiki/Neonatal_withdrawal
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