Risk and Treatability of Neonatal Abstinence Syndrome
"Untreated opiate dependence in pregnant women is associated with many environmental and medical factors that contribute to poor maternal and child outcomes. Illicit opioid consumption is associated with a sixfold increase in obstetric complications such as low birth weight, toxaemia, third trimester bleeding, malpresentation, puerperal morbidity (2), foetal distress and meconium aspiration. Neonatal complications include narcotic withdrawal, postnatal growth deficiency, microcephaly, neurobehavioural problems, increase in neonatal mortality and a 74-fold increase in sudden infant death syndrome (Dattel, 1990; Fajemirokun-Odudeyi et al., 2006; Ludlow et al., 2004). Neonates born to mothers chronically abusing illicit opioids or provided with maternal medication-assisted treatment, such as methadone or buprenorphine, are frequently born with a passive dependency to those specific agents. Intrauterine exposition to all of the commonly used opioids, including heroin and methadone, but also prescription drugs (OxyContin, Percodan, Vicodin, Percocet and Dilaudid), sedative hypnotics such as benzodiazepines (e.g. Diazepam) and barbiturates can produce neonatal abstinence syndrome (NAS) after disruption of the trans-placental passage of drugs at birth. NAS is characterised by signs and symptoms of the central nervous system, hyperirritability, gastrointestinal dysfunction and respiratory and autonomic nervous system symptoms (Kaltenbach et al., 1998). However, with the current medical knowledge NAS is an easily treatable condition and no infant mortality should occur as a result of NAS."