title: Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication.
abstract: OBJECTIVE
  To identify factors that predict the expression of neonatal abstinence syndrome (NAS) in infants exposed to methadone or buprenorphine in utero.
  
  
  METHODS
  Multi-site randomized clinical trial in which infants were observed for a minimum of 10 days following birth, and assessed for NAS symptoms by trained raters.
  
  
  METHODS
  A total of 131 infants born to opioid dependent mothers, 129 of whom were available for NAS assessment.
  
  
  METHODS
  Generalized linear modeling was performed using maternal and infant characteristics to predict: peak NAS score prior to treatment, whether an infant required NAS treatment, length of NAS treatment and total dose of morphine required for treatment of NAS symptoms.
  
  
  RESULTS
  Of the sample, 53% (68 infants) required treatment for NAS. Lower maternal weight at delivery, later estimated gestational age (EGA), maternal use of selective serotonin re-uptake inhibitors (SSRIs), vaginal delivery and higher infant birthweight predicted higher peak NAS scores. Higher infant birthweight and greater maternal nicotine use at delivery predicted receipt of NAS treatment for infants. Maternal use of SSRIs, higher nicotine use and fewer days of study medication received also predicted total dose of medication required to treat NAS symptoms. No variables predicted length of treatment for NAS.
  
  
  CONCLUSIONS
  Maternal weight at delivery, estimated gestational age, infant birthweight, delivery type, maternal nicotine use and days of maternal study medication received and the use of psychotropic medications in pregnancy may play a role in the expression of neonatal abstinence syndrome severity in infants exposed to either methadone or buprenorphine.
authors.affiliation: Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA. karol.kaltenbach@jefferson.edu
authors.forename: Karol
authors.initials: K
authors.lastname: Kaltenbach
authors.forename: Amber M
authors.initials: AM
authors.lastname: Holbrook
authors.forename: Mara G
authors.initials: MG
authors.lastname: Coyle
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Heil
authors.forename: Amy L
authors.initials: AL
authors.lastname: Salisbury
authors.forename: Susan M
authors.initials: SM
authors.lastname: Stine
authors.forename: Peter R
authors.initials: PR
authors.lastname: Martin
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D001724:Birth Weight / Q000502:physiology; D002047:Buprenorphine / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D016014:Linear Models; D008691:Methadone / Q000009:adverse effects*; D009020:Morphine / Q000008:administration & dosage; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000534:rehabilitation; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone; D009020:Morphine; D017367:Selective Serotonin Reuptake Inhibitors