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Opiate v CNS Depressant Therapy in Neonatal Drug Abstinence Syndrome

Opiate v CNS Depressant Therapy in Neonatal Drug Abstinence Syndrome Abstract • Paregoric and phenobarbital, administered randomly in 153 passively addicted neonates, initially appeared to control neonatal abstinence signs equally well. However, seven of the 62 phenobarbital treated newborns had abstinence-associated seizures within the first month of life, while none of 49 paregoric-treated neonates had seizures. Forty-two neonates initially requiring no specific pharmacotherapy for abstinence signs were born to mothers taking less methadone hydrochloride just before delivery. Five of those 42 neonates, however, had seizures within the first 14 days of life. Seizure occurrence could not be predicted from analysis of early abstinence patterns. We consider paregoric to be the treatment of choice for the neonatal abstinence syndrome. Phenobarbital use should be monitored with serum drug levels and modification of recommended dosage regimens considered. (Am J Dis Child 1983;137:378-382) References 1. Hill RM, Desmond MM: Management of the narcotic withdrawal syndrome in the neonate . Pediatr Clin North Am 1963;10:67-85. 2. Reddy AM, Harper RG, Stern G: Observations on heroin and methadone withdrawal in the newborn . Pediatrics 1971;48:353-357. 3. Zelson C, Rubio E, Wasserman E: Neonatal narcotic addiction: Ten-year observation . Pediatrics 1971;48:178-189. 4. Ostrea EM Jr, Chavez CJ, Strauss ME: A study of factors that influence the severity of neonatal narcotic withdrawal . J Pediatr 1976;88:642-645.Crossref 5. Kandall SR, Albin S, Gartner LM, et al: The narcotic-dependent mother: Fetal and neonatal consequences . Early Hum Devel 1977;1/2:159-169.Crossref 6. Madden JD, Chappel JN, Zuspan F, et al: Observation and treatment of neonatal narcotic withdrawal . Am J Obstet Gynecol 1977;127:199-201. 7. Harper RG, Solish G, Feingold E, et al: Maternal ingested methadone, body fluid methadone, and the neonatal withdrawal syndrome . Am J Obstet Gynecol 1977;129:417-424. 8. Finnegan LP: Pathophysiological and behavioural effects of the transplacental transfer of narcotic drugs to the foetuses and neonates of narcotic-dependent mothers . Bull Narc 1979; 31:1-58. 9. Kahn EJ, Neumann LL, Polk GA: The course of the heroin withdrawal syndrome in newborn infants treated with phenobarbital or chlorpromazine . J Pediatr 1969;75:495-500.Crossref 10. Rajegowda BK, Glass L, Evans HE, et al: Methadone withdrawal in newborn infants . J Pediatr 1972;81:532-534.Crossref 11. Kron RE, Litt M, Pheonix MD, et al: Neonatal narcotic abstinence: Effects of pharmacotherapeutic agents and maternal drug usage on nutritive sucking behavior . J Pediatr 1976;88: 637-641.Crossref 12. Dole VP, Kim WK, Eglitis I: Detection of narcotic drugs, tranquilizers, amphetamines, and barbiturates in urine . JAMA 1966;198:349-352.Crossref 13. Lipsitz PJ: A proposed narcotic withdrawal score for use with newborn infants . Clin Pediatr 1975;14:592-594.Crossref 14. Treatment of neonatal withdrawal syndrome . Med Lett Drugs Ther 1973;15:46-48. 15. Rothstein P, Gould JB: Born with a habit . Pediatr Clin North Am 1974;21:307-321. 16. Ostrea EM Jr, Wooley PV Jr: Infants of drug addicted mothers , in Gellis SS, Kagan BM (eds): Current Pediatric Therapy , Philadelphia, WB Saunders Co, 1978, vol 8, pp 780-782. 17. Herzlinger RA, Kandall SR, Vaughan HG Jr: Neonatal seizures associated with narcotic withdrawal . J Pediatr 1977;91:638-641.Crossref 18. Dole VP, Kreek MJ: Methadone plasma level: Sustained by a reservoir of drug in tissue . Proc Natl Acad Sci USA 1973;70:10.Crossref 19. Kandall SR, Gartner LM: Late presentation of drug withdrawal in newborns . Am J Dis Child 1974;127:58-61. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

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References (23)

Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1983.02140300056015
Publisher site
See Article on Publisher Site

Abstract

Abstract • Paregoric and phenobarbital, administered randomly in 153 passively addicted neonates, initially appeared to control neonatal abstinence signs equally well. However, seven of the 62 phenobarbital treated newborns had abstinence-associated seizures within the first month of life, while none of 49 paregoric-treated neonates had seizures. Forty-two neonates initially requiring no specific pharmacotherapy for abstinence signs were born to mothers taking less methadone hydrochloride just before delivery. Five of those 42 neonates, however, had seizures within the first 14 days of life. Seizure occurrence could not be predicted from analysis of early abstinence patterns. We consider paregoric to be the treatment of choice for the neonatal abstinence syndrome. Phenobarbital use should be monitored with serum drug levels and modification of recommended dosage regimens considered. (Am J Dis Child 1983;137:378-382) References 1. Hill RM, Desmond MM: Management of the narcotic withdrawal syndrome in the neonate . Pediatr Clin North Am 1963;10:67-85. 2. Reddy AM, Harper RG, Stern G: Observations on heroin and methadone withdrawal in the newborn . Pediatrics 1971;48:353-357. 3. Zelson C, Rubio E, Wasserman E: Neonatal narcotic addiction: Ten-year observation . Pediatrics 1971;48:178-189. 4. Ostrea EM Jr, Chavez CJ, Strauss ME: A study of factors that influence the severity of neonatal narcotic withdrawal . J Pediatr 1976;88:642-645.Crossref 5. Kandall SR, Albin S, Gartner LM, et al: The narcotic-dependent mother: Fetal and neonatal consequences . Early Hum Devel 1977;1/2:159-169.Crossref 6. Madden JD, Chappel JN, Zuspan F, et al: Observation and treatment of neonatal narcotic withdrawal . Am J Obstet Gynecol 1977;127:199-201. 7. Harper RG, Solish G, Feingold E, et al: Maternal ingested methadone, body fluid methadone, and the neonatal withdrawal syndrome . Am J Obstet Gynecol 1977;129:417-424. 8. Finnegan LP: Pathophysiological and behavioural effects of the transplacental transfer of narcotic drugs to the foetuses and neonates of narcotic-dependent mothers . Bull Narc 1979; 31:1-58. 9. Kahn EJ, Neumann LL, Polk GA: The course of the heroin withdrawal syndrome in newborn infants treated with phenobarbital or chlorpromazine . J Pediatr 1969;75:495-500.Crossref 10. Rajegowda BK, Glass L, Evans HE, et al: Methadone withdrawal in newborn infants . J Pediatr 1972;81:532-534.Crossref 11. Kron RE, Litt M, Pheonix MD, et al: Neonatal narcotic abstinence: Effects of pharmacotherapeutic agents and maternal drug usage on nutritive sucking behavior . J Pediatr 1976;88: 637-641.Crossref 12. Dole VP, Kim WK, Eglitis I: Detection of narcotic drugs, tranquilizers, amphetamines, and barbiturates in urine . JAMA 1966;198:349-352.Crossref 13. Lipsitz PJ: A proposed narcotic withdrawal score for use with newborn infants . Clin Pediatr 1975;14:592-594.Crossref 14. Treatment of neonatal withdrawal syndrome . Med Lett Drugs Ther 1973;15:46-48. 15. Rothstein P, Gould JB: Born with a habit . Pediatr Clin North Am 1974;21:307-321. 16. Ostrea EM Jr, Wooley PV Jr: Infants of drug addicted mothers , in Gellis SS, Kagan BM (eds): Current Pediatric Therapy , Philadelphia, WB Saunders Co, 1978, vol 8, pp 780-782. 17. Herzlinger RA, Kandall SR, Vaughan HG Jr: Neonatal seizures associated with narcotic withdrawal . J Pediatr 1977;91:638-641.Crossref 18. Dole VP, Kreek MJ: Methadone plasma level: Sustained by a reservoir of drug in tissue . Proc Natl Acad Sci USA 1973;70:10.Crossref 19. Kandall SR, Gartner LM: Late presentation of drug withdrawal in newborns . Am J Dis Child 1974;127:58-61.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Apr 1, 1983

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