Neonatal abstinence syndrome - Revision history

Danbot: Add MedicationDose entries (morphine PO/IV, buprenorphine, phenobarbital) with SMW annotations

2026-03-20T18:48:04Z

Add MedicationDose entries (morphine PO/IV, buprenorphine, phenobarbital) with SMW annotations

@@ Line 51: / Line 51: @@
 **16mg/kg load divided into two consecutive feedings for day 1
 **24 hrs later, use 2-8mg/kg/day maintenance dose
 ==Disposition==

ClaireLewis: /* Clinical Features */

2019-10-06T18:30:05Z

Clinical Features

← Older revision		Revision as of 18:30, 6 October 2019
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	==Clinical Features==		==Clinical Features==
	*Agitated - high-pitched cry, restlessness, [[tremor]]s, hypertonia, [[seizure (peds)\|convulsions]]		*Agitated - high-pitched cry, restlessness, [[tremor]]s, hypertonia, [[seizure (peds)\|convulsions]]
	*Vasomotor - sweating, [[fever (~~peds~~)\|fever]]		*Vasomotor - sweating, [[fever (Peds)\|fever]]
	*Respiratory - nasal congestion, persistent sneezing, [[shortness of breath (peds)\|RR > 60/min]], nasal flaring		*Respiratory - nasal congestion, persistent sneezing, [[shortness of breath (peds)\|RR > 60/min]], nasal flaring
	*Metabolic - [[failure to thrive (peds)\|poor feeding]], [[vomiting]], [[diarrhea (peds)\|loose stools]]		*Metabolic - [[failure to thrive (peds)\|poor feeding]], [[vomiting]], [[diarrhea (peds)\|loose stools]]

ClaireLewis at 18:28, 6 October 2019

2019-10-06T18:28:56Z

← Older revision		Revision as of 18:28, 6 October 2019
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	==Background==		==Background==
	*Condition caused by neonatal withdrawal from substance exposure in utero		*Condition caused by neonatal withdrawal from substance exposure in utero
	**Withdrawal within first 24-48 hrs → fetal alcohol syndrome		**Withdrawal within first 24-48 hrs → fetal [[alcohol]] syndrome
	**Withdrawal within 48-72 hrs → heroin		**Withdrawal within 48-72 hrs → [[heroin]]
	**Withdrawal at 7-14 days → methadone		**Withdrawal at 7-14 days → [[methadone]]
	*Incidence has quadrupled since 1999 from 1.5 per 1000 hospital births to 6.0 per 1000 in 2013<ref>Ko JY et al. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. Weekly / August 12, 2016 / 65(31);799–802.</ref>		*Incidence has quadrupled since 1999 from 1.5 per 1000 hospital births to 6.0 per 1000 in 2013<ref>Ko JY et al. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. Weekly / August 12, 2016 / 65(31);799–802.</ref>
	*Polysubstance withdrawal must also be considered		*Polysubstance withdrawal must also be considered
Line 9:		Line 9:
	==Clinical Features==		==Clinical Features==
	*Agitated - high-pitched cry, restlessness, [[tremor]]s, hypertonia, [[seizure (peds)\|convulsions]]		*Agitated - high-pitched cry, restlessness, [[tremor]]s, hypertonia, [[seizure (peds)\|convulsions]]
	*Vasomotor - sweating, fever		*Vasomotor - sweating, [[fever (peds)\|fever]]
	*Respiratory - nasal congestion, persistent sneezing, [[shortness of breath (peds)\|RR > 60/min]], nasal flaring		*Respiratory - nasal congestion, persistent sneezing, [[shortness of breath (peds)\|RR > 60/min]], nasal flaring
	*Metabolic - [[failure to thrive (peds)\|poor feeding]], [[vomiting]], [[diarrhea (peds)\|loose stools]]		*Metabolic - [[failure to thrive (peds)\|poor feeding]], [[vomiting]], [[diarrhea (peds)\|loose stools]]
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	*[[Hypoglycemia]]		*[[Hypoglycemia]]
	*Vertically transmitted diseases ([[viral hepatitis]] [[HIV]], etc.)		*Vertically transmitted diseases ([[viral hepatitis]] [[HIV]], etc.)
	*Other withdrawal (caffeine, cocaine, nicotine, amphetamines, SSRIs)		*Other withdrawal ([[caffeine withdrawal\|caffeine]], [[cocaine withdrawal\|cocaine]], nicotine, [[amphetamines]], [[SSRIs]])

	==Evaluation==		==Evaluation==
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	**[[Midazolam]] 0.1mg/kg IV q3hrs or 0.3mg/kg PO q3hrs		**[[Midazolam]] 0.1mg/kg IV q3hrs or 0.3mg/kg PO q3hrs
	**OR [[phenobarbital]] 3mg/kg IV or PO q24hrs		**OR [[phenobarbital]] 3mg/kg IV or PO q24hrs
	*Phenobarbital for seizures OR side effect limiting morphine effects OR max morphine dose reached		*[[Phenobarbital]] for seizures OR side effect limiting morphine effects OR max morphine dose reached
	**16mg/kg load divided into two consecutive feedings for day 1		**16mg/kg load divided into two consecutive feedings for day 1
	**24 hrs later, use 2-8mg/kg/day maintenance dose		**24 hrs later, use 2-8mg/kg/day maintenance dose

ClaireLewis at 01:24, 15 September 2019

2019-09-15T01:24:02Z

← Older revision		Revision as of 01:24, 15 September 2019
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	==Clinical Features==		==Clinical Features==
	*Agitated - high-pitched cry, restlessness, ~~tremors~~, hypertonia, convulsions		*Agitated - high-pitched cry, restlessness, [[tremor]]s, hypertonia, [[seizure (peds)\|convulsions]]
	*Vasomotor - sweating, fever		*Vasomotor - sweating, fever
	*Respiratory - nasal congestion, persistent sneezing, RR > 60/min, nasal flaring		*Respiratory - nasal congestion, persistent sneezing, [[shortness of breath (peds)\|RR > 60/min]], nasal flaring
	*Metabolic - poor feeding, vomiting, loose stools		*Metabolic - [[failure to thrive (peds)\|poor feeding]], [[vomiting]], [[diarrhea (peds)\|loose stools]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	*[[Hypocalcemia]]		*[[Hypocalcemia]]
	*[[Hypoglycemia]]		*[[Hypoglycemia]]
	*Vertically transmitted diseases (~~HepB, HepC,~~ [[HIV]], etc.)		*Vertically transmitted diseases ([[viral hepatitis]] [[HIV]], etc.)
	*Other withdrawal (caffeine, cocaine, nicotine, amphetamines, SSRIs)		*Other withdrawal (caffeine, cocaine, nicotine, amphetamines, SSRIs)

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	==Management==		==Management==
	*Supportive - swaddling to decrease sensory stimulation, frequent small feedings of 24 cal/oz formula		*Supportive - swaddling to decrease sensory stimulation, frequent small feedings of 24 cal/oz formula
	*~~Opiates~~ when supportive measures fail		*[[Opioids]] when supportive measures fail
	*Morphine is 1st line for infants exposed to '''both''' opioids and benzos		**[[Morphine]] is 1st line for infants exposed to '''both''' opioids and benzos
	**Neonatal morphine 0.4mg/ml PO sln		***Neonatal morphine 0.4mg/ml PO sln
	***Watch for side effect limiting dose (urinary retention)		****Watch for side effect limiting dose ([[urinary retention]])
	***Withdrawal symptoms need to be stabilized for 3-5 days before taper		****Withdrawal symptoms need to be stabilized for 3-5 days before taper
	***Mother's methadone < 50mg (or other opiate)		***Mother's [[methadone]] < 50mg (or other opiate)
	****Start morphine PO sln 0.1mg/kg q3hrs with feeds		****Start morphine PO sln 0.1mg/kg q3hrs with feeds
	****Increase by 0.1mg/kg hourly if NAS score ≥ 8, max 1mg/kg		****Increase by 0.1mg/kg hourly if NAS score ≥ 8, max 1mg/kg
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	***Load 30 mcg/kg over 1hr, then infusion at 2 mcg/kg/hr		***Load 30 mcg/kg over 1hr, then infusion at 2 mcg/kg/hr
	***Increase by 1 mcg/kg/hr hourly until NAS < 8, max 6 mcg/kg/hr		***Increase by 1 mcg/kg/hr hourly until NAS < 8, max 6 mcg/kg/hr
	*Longer acting buprenorphine may significantly reduce hospital admission and treatment duration as compared to morphine<ref>Kraft WK et al. Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. May 4, 2017DOI: 10.1056/NEJMoa1614835.</ref>		*Longer acting [[buprenorphine]] may significantly reduce hospital admission and treatment duration as compared to morphine<ref>Kraft WK et al. Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. May 4, 2017DOI: 10.1056/NEJMoa1614835.</ref>
	**Morphine q4 hours vs. buprenorphine q8 hours if NAS scale > 12		**Morphine q4 hours vs. buprenorphine q8 hours if NAS scale > 12
	**[[Buprenorphine]] dosed initially at 5 mcg/kg q8 hrs to max dose of 20 mcg/kg q8 hrs		**[[Buprenorphine]] dosed initially at 5 mcg/kg q8 hrs to max dose of 20 mcg/kg q8 hrs
	*~~Benzo~~ withdrawal treatment		*[[Benzodiazepine withdrawal]] treatment
	**Midazolam 0.1mg/kg IV q3hrs or 0.3mg/kg PO q3hrs		**[[Midazolam]] 0.1mg/kg IV q3hrs or 0.3mg/kg PO q3hrs
	**OR phenobarbital 3mg/kg IV or PO q24hrs		**OR [[phenobarbital]] 3mg/kg IV or PO q24hrs
	*Phenobarbital for seizures OR side effect limiting morphine effects OR max morphine dose reached		*Phenobarbital for seizures OR side effect limiting morphine effects OR max morphine dose reached
	**16mg/kg load divided into two consecutive feedings for day 1		**16mg/kg load divided into two consecutive feedings for day 1

Mholtz at 04:28, 28 May 2017

2017-05-28T04:28:23Z

← Older revision		Revision as of 04:28, 28 May 2017
Line 1:		Line 1:
	==Background==		==Background==
	*Incidence has quadrupled since 1999 from 1.5 per 1000 hospital births to 6.0 per 1000 in 2013<ref>Ko JY et al. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. Weekly / August 12, 2016 / 65(31);799–802.</ref>
	*Condition caused by neonatal withdrawal from substance exposure in utero		*Condition caused by neonatal withdrawal from substance exposure in utero
	**Withdrawal within first 24-48 hrs → fetal alcohol syndrome		**Withdrawal within first 24-48 hrs → fetal alcohol syndrome
	**Withdrawal within 48-72 hrs → heroin		**Withdrawal within 48-72 hrs → heroin
	**Withdrawal at 7-14 days → methadone		**Withdrawal at 7-14 days → methadone
			*Incidence has quadrupled since 1999 from 1.5 per 1000 hospital births to 6.0 per 1000 in 2013<ref>Ko JY et al. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. Weekly / August 12, 2016 / 65(31);799–802.</ref>
	*Polysubstance withdrawal must also be considered		*Polysubstance withdrawal must also be considered

Line 60:		Line 60:
	==References==		==References==
	<references/>		<references/>
	*Hudak ML, Tan RC. Neonatal Drug Withdrawal. Pediatrics. January 2012. 129(2):e540-560.
	*Lainwala S, Brown ER, Weinschenk NP, Blackwell MT, Hagadorn JI. A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care. 2005 Oct. 5(5):265-72.
	*Hall ES, Wexelblatt SL, Crowley M, Grow JL, Jasin LR, Klebanoff MA, et al. A multicenter cohort study of treatments and hospital outcomes in neonatal abstinence syndrome. Pediatrics. 2014 Aug. 134(2):e527-34.
	*Pullen L. Neonatal Abstinence Syndrome: Stringent Weaning Protocol Best. Available at http://www.medscape.com/viewarticle/829115. Accessed: August 12, 2016.

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Toxicology]]		[[Category:Toxicology]]

Kxl328: /* Management */

2017-05-28T03:08:50Z

Management

← Older revision		Revision as of 03:08, 28 May 2017
Line 30:		Line 30:
	*Opiates when supportive measures fail		*Opiates when supportive measures fail
	*Morphine is 1st line for infants exposed to '''both''' opioids and benzos		*Morphine is 1st line for infants exposed to '''both''' opioids and benzos
	*Longer acting buprenorphine may significantly reduce hospital admission and treatment duration as compared to morphine<ref>Kraft WK et al. Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. May 4, 2017DOI: 10.1056/NEJMoa1614835.</ref>
	**Morphine q4 hours vs. buprenorphine q8 hours if NAS scale > 12
	**[[Buprenorphine]] dosed initially at 5 mcg/kg q8 hrs to max dose of 20 mcg/kg q8 hrs
	**Neonatal morphine 0.4mg/ml PO sln		**Neonatal morphine 0.4mg/ml PO sln
	***Watch for side effect limiting dose (urinary retention)		***Watch for side effect limiting dose (urinary retention)
Line 45:		Line 42:
	***Load 30 mcg/kg over 1hr, then infusion at 2 mcg/kg/hr		***Load 30 mcg/kg over 1hr, then infusion at 2 mcg/kg/hr
	***Increase by 1 mcg/kg/hr hourly until NAS < 8, max 6 mcg/kg/hr		***Increase by 1 mcg/kg/hr hourly until NAS < 8, max 6 mcg/kg/hr
			*Longer acting buprenorphine may significantly reduce hospital admission and treatment duration as compared to morphine<ref>Kraft WK et al. Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. May 4, 2017DOI: 10.1056/NEJMoa1614835.</ref>
			**Morphine q4 hours vs. buprenorphine q8 hours if NAS scale > 12
			**[[Buprenorphine]] dosed initially at 5 mcg/kg q8 hrs to max dose of 20 mcg/kg q8 hrs
	*Benzo withdrawal treatment		*Benzo withdrawal treatment
	**Midazolam 0.1mg/kg IV q3hrs or 0.3mg/kg PO q3hrs		**Midazolam 0.1mg/kg IV q3hrs or 0.3mg/kg PO q3hrs

Kxl328: /* Management */

2017-05-28T03:08:17Z

Management

← Older revision		Revision as of 03:08, 28 May 2017
Line 30:		Line 30:
	*Opiates when supportive measures fail		*Opiates when supportive measures fail
	*Morphine is 1st line for infants exposed to '''both''' opioids and benzos		*Morphine is 1st line for infants exposed to '''both''' opioids and benzos
			*Longer acting buprenorphine may significantly reduce hospital admission and treatment duration as compared to morphine<ref>Kraft WK et al. Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. May 4, 2017DOI: 10.1056/NEJMoa1614835.</ref>
			**Morphine q4 hours vs. buprenorphine q8 hours if NAS scale > 12
			**[[Buprenorphine]] dosed initially at 5 mcg/kg q8 hrs to max dose of 20 mcg/kg q8 hrs
	**Neonatal morphine 0.4mg/ml PO sln		**Neonatal morphine 0.4mg/ml PO sln
	***Watch for side effect limiting dose (urinary retention)		***Watch for side effect limiting dose (urinary retention)

Rossdonaldson1: Text replacement - " US " to " ultrasound "

2016-11-13T20:40:22Z

Text replacement - " US " to " ultrasound "

← Older revision		Revision as of 20:40, 13 November 2016
Line 24:		Line 24:
	*Pharmacologic treatment when 3 consecutive ≥ 8 on NAS([http://www.lkpz.nl/docs/lkpz_pdf_1310485469.pdf Finnegan scale]		*Pharmacologic treatment when 3 consecutive ≥ 8 on NAS([http://www.lkpz.nl/docs/lkpz_pdf_1310485469.pdf Finnegan scale]
	*Enzyme immunoassay, urine toxicology, meconium analysis		*Enzyme immunoassay, urine toxicology, meconium analysis
	*Consider cranial US for cocaine-exposed neonates with abnormal neurologic signs		*Consider cranial [[ultrasound]] for cocaine-exposed neonates with abnormal neurologic signs

	==Management==		==Management==

Kxl328: /* References */

2016-08-12T14:28:55Z

References

← Older revision		Revision as of 14:28, 12 August 2016
Line 57:		Line 57:
	==References==		==References==
	<references/>		<references/>
			*Hudak ML, Tan RC. Neonatal Drug Withdrawal. Pediatrics. January 2012. 129(2):e540-560.
			*Lainwala S, Brown ER, Weinschenk NP, Blackwell MT, Hagadorn JI. A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care. 2005 Oct. 5(5):265-72.
			*Hall ES, Wexelblatt SL, Crowley M, Grow JL, Jasin LR, Klebanoff MA, et al. A multicenter cohort study of treatments and hospital outcomes in neonatal abstinence syndrome. Pediatrics. 2014 Aug. 134(2):e527-34.
			*Pullen L. Neonatal Abstinence Syndrome: Stringent Weaning Protocol Best. Available at http://www.medscape.com/viewarticle/829115. Accessed: August 12, 2016.

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Toxicology]]		[[Category:Toxicology]]

Kxl328 at 14:26, 12 August 2016

2016-08-12T14:26:24Z

← Older revision		Revision as of 14:26, 12 August 2016
Line 1:		Line 1:
	==Background==		==Background==
			*Incidence has quadrupled since 1999 from 1.5 per 1000 hospital births to 6.0 per 1000 in 2013<ref>Ko JY et al. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. Weekly / August 12, 2016 / 65(31);799–802.</ref>
	*Condition caused by neonatal withdrawal from substance exposure in utero		*Condition caused by neonatal withdrawal from substance exposure in utero
	**Withdrawal within first 24-48 hrs → fetal alcohol syndrome		**Withdrawal within first 24-48 hrs → fetal alcohol syndrome

← Older revision		Revision as of 18:30, 6 October 2019
Line 9:		Line 9:
	==Clinical Features==		==Clinical Features==
	*Agitated - high-pitched cry, restlessness, [[tremor]]s, hypertonia, [[seizure (peds)\|convulsions]]		*Agitated - high-pitched cry, restlessness, [[tremor]]s, hypertonia, [[seizure (peds)\|convulsions]]
	*Vasomotor - sweating, [[fever (~~peds~~)\|fever]]		*Vasomotor - sweating, [[fever (Peds)\|fever]]
	*Respiratory - nasal congestion, persistent sneezing, [[shortness of breath (peds)\|RR > 60/min]], nasal flaring		*Respiratory - nasal congestion, persistent sneezing, [[shortness of breath (peds)\|RR > 60/min]], nasal flaring
	*Metabolic - [[failure to thrive (peds)\|poor feeding]], [[vomiting]], [[diarrhea (peds)\|loose stools]]		*Metabolic - [[failure to thrive (peds)\|poor feeding]], [[vomiting]], [[diarrhea (peds)\|loose stools]]