Neonatal Abstinence Syndrome
Neonatal abstinence syndrome is a combination of neurologic, gastrointestinal, and autonomic dysregulation symptoms. This combination makes it difficult to deal with in an absence of medication. Methadone, a synthetic analgesic opioid. Similar to morphine effect, but less in sedation severity, considered as the gold standard treatment in pregnancy opioid abstinence, since around 45 years. As metabolism accelerate in pregnancy, Methadone’s effect end faster than in non-pregnant women. This make both mother and fetus exposed to withdrawal symptoms, and thus contribute to higher NAS complications. Many methods when giving methadone is used. The most common one is a single dose daily. The second is restricted doses to prevent fetal exposure. Another
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method is to reduce the dose at late stages of pregnancy. Eventually, experts are advocating for using a multiple doses per day, mostly two, to treat the maternal withdrawal. Their recommendation comes to prevent fetal exposure to peak levels of methadone, and avoiding the extremes of it. One high concentrated dose of methadone has shown a significant reduction in fetal heart rate & fetal motor activity at peak levels. These parameters became normal on twice-daily doses according to Jasson et al. (2009).
A cohort study that was done, between 2008-2013, to evaluate the effect of multiple methadone doses daily in pregnancy on neonatal outcomes.
By splitting the needed doses of methadone, forward results were documented: There was no correlation between methadone dose and the baby’s treatment. There was also no difference between the mothers who conceived on methadone, and the ones who conceived off-it. Male babies were more likely to require a treatment. Although in other studies, gender played no role in treatment wise. Also, low serum levels, less than 365 ng/ml, was related to treatment needs. Fetal responded to withdrawal symptoms by increasing in their movement. This hyperactivity was avoided with higher methadone dose. LOS has correlated with the gestational age. Overall studies showed high relationship between dose plan and NAS severity, rather than the dose itself. Therefore, multiple methadone dose plan is helpful in limiting withdrawal symptoms and hyperactivity that baby may suffer from intra-uterinaly. It also, beneficial to maintain proper continuous dose all across the day with no peak negative side effects. In addition, it increases maternal and neonatal recovery, with reducing the severity of NAS. Any opposing studies might differ in the dosing process considering special metabolic status of the pregnant, and intrauterine withdrawal
stress.
method is to reduce the dose at late stages of pregnancy. Eventually, experts are advocating for using a multiple doses per day, mostly two, to treat the maternal withdrawal. Their recommendation comes to prevent fetal exposure to peak levels of methadone, and avoiding the extremes of it. One high concentrated dose of methadone has shown a significant reduction in fetal heart rate & fetal motor activity at peak levels. These parameters became normal on twice-daily doses according to Jasson et al. (2009).
A cohort study that was done, between 2008-2013, to evaluate the effect of multiple methadone doses daily in pregnancy on neonatal outcomes.
By splitting the needed doses of methadone, forward results were documented: There was no correlation between methadone dose and the baby’s treatment. There was also no difference between the mothers who conceived on methadone, and the ones who conceived off-it. Male babies were more likely to require a treatment. Although in other studies, gender played no role in treatment wise. Also, low serum levels, less than 365 ng/ml, was related to treatment needs. Fetal responded to withdrawal symptoms by increasing in their movement. This hyperactivity was avoided with higher methadone dose. LOS has correlated with the gestational age. Overall studies showed high relationship between dose plan and NAS severity, rather than the dose itself. Therefore, multiple methadone dose plan is helpful in limiting withdrawal symptoms and hyperactivity that baby may suffer from intra-uterinaly. It also, beneficial to maintain proper continuous dose all across the day with no peak negative side effects. In addition, it increases maternal and neonatal recovery, with reducing the severity of NAS. Any opposing studies might differ in the dosing process considering special metabolic status of the pregnant, and intrauterine withdrawal
stress.