Email Service Notes 5th September (Eddie)

Original:

Aim: Opioid use among women of reproductive age had dramatically increased, with approximately 28% of privately insured and 39% of Medicaid-enrolled women aged 15 – 44 years filling a prescription for an opioid medication each year for 5 consecutive year. In utero exposure to opioids in pregnancy were also associated with a 60–80% risk of NAS. This review was to define current practices including non-pharmacologic and pharmacologic therapy regarding the approach to the pregnant mother and neonate with prenatal opiate exposure.

Methods: The benefit and risk profile of non-pharmacologic treatment and pharmacologic therapy were assessed.
Non pharmacologic treatment included creating a quiet and soothing environment with the avoidance of excessive environment, frequent hypocaloric feeds, rooming-in and breastfeeding. Pharmacologic therapy included opioid such as Morphine, Methadone, Buprenorphine, Phenobarbital, Clonidine in hospital and out of hospital treatment and long-term follow-up.

Results: Regarding Buprenorphine treatment for maternal addiction and neonatal NAS treatment, it was superior to methadone treatment such as: a diminished risk of overdose, less abrupt withdrawal, fewer drug-drug interactions and easy to access. In addition, Buprenorphine treatment was associated with a significantly lower cumulative amount of morphine needed to treat NAS, shorter duration of treatment, and length of hospital stay for infants with NAS. However, it might presented the risks of increasing dropout rates, potential risk of diversion and lack of long term pregnancy and childhood safety data.

Conclusion: It was imperative to address significant knowledge gaps regarding optimal prenatal and postnatal care. A multidisciplinary collaborate was needed among obstetricians, pediatricians, nurses, social workers, addiction specialists, and politicians.

Edit:

Aim: Opioid use among women of reproductive age has dramatically increased, with approximately 28% of privately insured and 39% of Medicaid-enrolled women aged 15 – 44 years filling a prescription for an opioid medication each year for 5 consecutive years. In utero exposure to opioids in pregnancy was also associated with a 60–80% risk of NAS. The goal of this review was / is? to define current practices including non-pharmacologic and pharmacologic therapy regarding the approach to the pregnant mother and neonate with prenatal opiate exposure.

Methods: The benefit and risk profile of non-pharmacologic treatment and pharmacologic therapy were assessed.
Non–pharmacologic treatment included creating a quiet and soothing environment with the avoidance of excessive environment [??missing word??], frequent hypocaloric feeds, rooming-in and breastfeeding. Pharmacologic therapy included opioids such as Morphine, Methadone, Buprenorphine, Phenobarbital, Clonidine in hospital and out of hospital treatment and long-term follow-up.

Results: Regarding Buprenorphine treatment for maternal addiction and neonatal NAS treatment, it was superior to methadone treatment in aspects such as: a diminished risk of overdose, less abrupt withdrawal, fewer drug-drug interactions and easy to access. In addition, Buprenorphine treatment was associated with a significantly lower cumulative amount of morphine needed to treat NAS, shorter duration of treatment, and length of hospital stay for infants with NAS. However, it might present the risk of increasing dropout rates, potential risk of diversion and lack of long term pregnancy and childhood safety data.

Conclusion: It was imperative to address significant knowledge gaps regarding optimal prenatal and postnatal care. A multidisciplinary collaboration was needed among obstetricians, pediatricians, nurses, social workers, addiction specialists, and politicians.