Methadone
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Neonatal abstinence syndrome: case report A 2-hour-old boy developed neonatal abstinence syndrome following in utero exposure to methadone. The mother of the boy, who had a significant history of opioids (heroin) abuse, had been receiving methadone as a substitution therapy. Her medical history was significant for one previous pregnancy and childbirth, and latent hepatits-C infection. Two years prior to the current pregnancy, she started receiving oral methadone syrup 100 mg/day (before pregnancy). During the last 2 months of current pregnancy, the dose was tapered to 35 mg/day. Her pregnancy was also complicated with acquired vaginal Streptococcus agalactiae infection. After a full-term pregnancy of 39 weeks, she delivered a male neonate (the patient) via normal vaginal delivery with Apgar score of 10 and weighing 3420g. From the second hour of life, his condition started to deteriorate. He developed peripheral cyanosis along with respiratory disturbances. On examination, he was noted suffering from respiratory acidosis and hypoxemia. Chest X-ray demonstrated lung interstitial markings. Due to the worsening condition, passive oxygenation in the incubator was started. Later, due to respiratory failure, it was changed to continuous positive airway pressure support (CPAP). Additionally, unspecified antibiotics and parenteral nutrition were started; however, his condition continued to deteriorate and he developed limb tremors along with agitation. The respiratory disturbance improved after 24 hours, and CPAP was removed. Enteral nutrition was also started. After a few hours, he developed clinical features of neonatal abstinence syndrome that included agitation, unsettled crying, tremors, difficulty in bottle-feeding (frantic sucking) and numerous loose and watery stools. He scored 16 on Finnegan neonatal abstinence scoring scale. Due to insufficient lactation, he was fed using modified milk and later with breast milk. He was continuously monitored during sleep. During the monitoring, he was noted with bradycardia during sleep. Examinations showed slow and impaired reflexes, foot clonus, tremor of the upper with lower limb, and frantic sucking. The neonate started receiving pharmacological and non-pharmacological treatment with morphine. He was placed in a calm and rocking environment. On day 15, improvement was noted in his condition. A Finnegan scale score of below 4 points was achieved. Other parameters were as follows: HR 140–168 /min and O2 saturation was 92–98%. He was discharged from hospital on day 22 after birth in stable condition. Napieralska M, et al. Neonatal abstinence syndrome in a newborn delivered by an opioid-dependent mother using methadone substitution therapy during pregnancy. Palliative 803504741 Medicine in Practice 14: 124-129, No. 2, 14 Jul 2020. Available from: URL: http://doi.org/10.5603/PMPI.2020.0012
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Reactions 3 Oct 2020 No. 1824
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