Archive for the ‘Withdrawal syndrome’ Category


Despite the availability of several abstinence scoring systems, none has been adopted as the standard. Finnegan neonatal abstinence scoring, consisting of weighted scoring of 31 items, was used for monitoring of NWS in our unit. Pharmacological treatment is indicated when the total abstinence score is >8 for three consecutive evaluations. The indications for drug therapy include seizures, poor feeding, diarrhea and vomiting resulting in excessive weight loss and dehydration, inability to sleep and fever unrelated to infection.   (more…)

codeine use (part 4)

The CYP2D6 gene is highly polymorphic, and the genotype of CYP2D6 determines the rate of metabolism of codeine. Individuals are catagorized into poor metabolizers, extensive metabolizers and ultrarapid metabolizers, depending on their CYP2D6 genotype. Poor metabolizers are unable to convert codeine to morphine efficiently and as a consequence may not experience pain relief. Ultrarapid metabolizers may metabolize codeine too efficiently, leading to morphine intoxication. Polymorphisms of CYP2D6 can be life threatening for some breastfed babies. A case of neonatal death due to opioid toxicity via breast milk from a mother who had been prescribed codeine for episiotomy pain has been reported. (more…)

maternal codeine use (part 3)

Discussion
Tylenol (active ingredient acetaminophen) is a popular North American brand of medications advertised for relieving pain, reducing fever and relieving the symptoms of allergies, cold, cough and flu. There are different formulations of Tylenol on the market with various combinations of medications. The mother of this infant was taking Tylenol 3 for migraine. One tablet of Tylenol 3 contains 300 mg of acetaminophen, 15 mg of caffeine and 30 mg of codeine phosphate. The mother was taking approximately six tablets of Tylenol 3 daily, which amounted to a codeine intake of 180 mg/day.
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Case presentation
A term male infant weighing 3687 g was born to a 30-year-old woman (gravida 6, para 4; four living children) by spontaneous vaginal delivery. Her maternal, prenatal and serological tests were negative, her group B streptococcus status was unknown and she had a positive urine test for Chlamydia trachomatis at 29 weeks, which was treated with azithromycin. She denied the use of any recreational drugs during pregnancy, and the pregnancy was otherwise uneventful. Her membranes ruptured at the time of birth and did not have any clinical signs of chorioamnionitis. The baby cried soon after birth and had Apgar scores of 9 and 9 at 1 min and 5 min, respectively. Umbilical arterial pH was 7.34 with a base excess of -3.
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maternal codeine use (part 1)

Neonatal withdrawal syndrome (NWS) is not an uncommon problem in neonatal intensive care units and is most commonly described in association with addicted mothers. It is common to prescribe analgesics during pregnancy for chronic pain disorders such as migraine or backache. Diagnosis of NWS could be delayed if a detailed history of maternal drug use is not obtained. Only a few cases have been reported in the literature regarding codeine withdrawal in neonates. NWS develops in 55% to 94% of newborns exposed to narcotics in utero, but the signs of withdrawal are nonspecific. (more…)

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