title: Narcotic-exposed neonates in a First Nations population in northwestern Ontario: incidence and implications.
abstract: OBJECTIVE
  To document the incidence of neonatal abstinence syndrome (NAS) and the rate of narcotic use during pregnancy in northwestern Ontario, where narcotic abuse is a growing social and medical problem.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  The Sioux Lookout Meno Ya Win Health Centre catchment area in northwestern Ontario.
  
  
  METHODS
  Mothers and neonates for the 482 live births that took place in the 18-month study period (January 2009 to June 2010).
  
  
  METHODS
  Maternal drug use and neonatal outcomes were documented.
  
  
  RESULTS
  The incidence of narcotic (oxycodone) abuse during pregnancy increased from a low of 8.4% at the beginning of the study period to a high of 17.2% by mid-2010. Narcotic-using mothers were more likely to also use nicotine and alcohol, to have premature deliveries, and to be episodic users. Narcotic-exposed neonates experienced NAS 29.5% of the time; daily maternal use was associated with a higher rate of NAS (66.0%). While all infants roomed in with their mothers, exposed infants were more likely to require transfer to a tertiary care nursery. Infants with severe NAS were treated with oral morphine and had significantly longer hospital stays compared with the entire cohort (4.5 vs 1.5 days, P = .004). Narcotic abuse during pregnancy in our region is not currently associated with increased rates of HIV or hepatitis C infection, as intravenous route of administration is less common at present than intranasal and oral ingestion.
  
  
  CONCLUSIONS
  Narcotic abuse during pregnancy is a considerable problem in First Nations communities in northwestern Ontario. Community-based initiatives need to be developed to address this issue, and medical and nursing staff need to develop surveillance, assessment, and therapeutic responses. Passive neonatal addiction and withdrawal result from maternal narcotic use during pregnancy. Rates of opioid use among pregnant Canadian women are unknown.
authors.affiliation: Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, Ont. lkelly@mcmaster.ca
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
authors.forename: Joe
authors.initials: J
authors.lastname: Dooley
authors.forename: Helen
authors.initials: H
authors.lastname: Cromarty
authors.forename: Bryanne
authors.initials: B
authors.lastname: Minty
authors.forename: Alanna
authors.initials: A
authors.lastname: Morgan
authors.forename: Sharen
authors.initials: S
authors.lastname: Madden
authors.forename: Wilma
authors.initials: W
authors.lastname: Hopman
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D007902:Length of Stay; D008431:Maternal-Fetal Exchange; D009020:Morphine / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000188:drug therapy / Q000208:ethnology*; D009864:Ontario / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000208:ethnology*; D010098:Oxycodone; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology*; D047928:Premature Birth / Q000208:ethnology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D010098:Oxycodone
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