Lactente em abstinência de cocaína, relato de caso / Neonatal abstinence from cocaine, a case report

Objetivo: descrever o caso de um lactente exposto à cocaína e as repercussões clínicas da sua ingestão por meio do leite materno. Relato do caso: lactente, com um mês e três dias de vida e peso de 3.920g vem à emergência, por quadro de hipoatividade, rebaixamento de sensório, choro e sangramento nasal. Afebril, irritada, chorosa, sem sinais de esforço ventilatório ou sangramentos ativos. Exames mostraram leucocitose 13490/uL, acidose metabólica discreta, aumento de transglutaminase oxalacética e provas de coagulação alargadas. Demais exames laboratoriais sem alterações e culturas negativas. Screening toxicológico revelou cocaína no plasma da lactente. O Centro de Informações Toxicológicas, recomendou monitorização e suporte clínico. A paciente recebeu alta da unidade de terapia intensiva para enfermaria cinco dias após admissão, com melhora do sensório, seguindo acompanhamento com a equipes especializadas. Conclusão: o pronto reconhecimento da síndrome de abstinência neonatal permite o melhor manejo da mesma em benefício dos pacientes. O diagnóstico diferencial com quadro séptico pode ser de grande importância em quadros como este.

Objective: describing a case of an infant exposed to cocaine through breast milk and its clinical repercussions. Case report: infant, one month and three days old, weighing 3,920g, came to the emergency room due to hypoactivity, sensory impairment and nose bleeding. Afebrile, irritated, tearful, no signs of ventilatory effort or active bleeding. Tests showed leukocytosis 13490/uL, mild metabolic acidosis, increased serum glutamic-oxaloacetic transaminase and enlarged coagulation tests. Other laboratory tests were normal. Toxicological screening revealed cocaine in the infant's plasma. Toxicological Information Center, recommended monitorization, and clinical support. The patient was discharged from the intensive care unit to the ward five days after admission, with sensorium improvement and a follow-up with specialized teams. Conclusions: prompt recognition of the neonatal abstinence syndrome allows for better management of it and high chances of recovery for patients. The differential diagnosis with septic condition can be of great importance in conditions like this one.

Síndrome de abstinencia neonatal debido a exposición prenatal al citalopram: a propósito de un caso / Neonatal abstinence syndrome due to prenatally citalopram exposure: A case report

El síndrome de abstinencia neonatal (SAN) debido a la exposición prenatal al citalopram se desarrolla durante los primeros días de vida, incluso con una exposición al fármaco en dosis bajas. El tratamiento de apoyo es la primera opción, aunque puede usarse el fenobarbital en el tratamiento de este síndrome. No debe interrumpirse la lactancia. Debe hacerse un seguimiento de estos recién nacidos para establecer el desenlace del SAN y las consecuencias en el desarrollo neurológico. En este artículo presentamos el caso de un recién nacido con SAN debido a exposición al citalopram en una dosis más baja que lo informado previamente en la bibliografía durante los últimos seis meses del embarazo. Se utilizó el fenobarbital debido al fracaso del tratamiento no farmacológico.

Neonatal abstinence syndrome (NAS) due to prenatally exposure to citalopram can develop during the first days of life even with low dose of drug exposure. Supportive management is the first choice but phenobarbital can be used in treatment of this syndrome. Breastfeeding should not be interrupted. These neonates should be followed both for NAS and neurodevelopmental outcome. In this article, we reported a newborn with NAS due to citalopram exposure with a lower dose than previously reported in the literature, during the last six months of pregnancy. Phenobarbital was used because of non-pharmacological treatment failure.

Revisión narrativa. Complicaciones en la madre, feto y neonato, derivadas del consumo de cocaína durante la gestación / Narrative review. Complications in the mother, fetus, and neonate due to cocaine use during pregnancy / Revisão narrativa. Complicações na mãe, feto e neonato, derivadas do consumo de cocaína durante a gestação

Latinoamérica reporta en las gestantes un consumo de alcohol del 44%, cigarrillo 51.8%, anfetaminas 8.3%, cocaína 2.5% y marihuana 2%. Las gestantes consumidoras representan un problema para las instituciones prestadoras de salud que exige intervenciones intersectoriales e interdisciplinarias por las consecuencias físicas, psicológicas, familiares y sociales que conlleva para la madre, el neonato y el infante. En esta revisión se describen las complicaciones físicas y conductuales en la madre, el feto y el neonato, que surgen por el consumo de cocaína y sus derivados durante la gestación. Se realizó una revisión narrativa a partir de la búsqueda de información científica indexada en las bases de datos Pubmed, Lilacs, Ovid, Science Direct entre el 2000 y el 2015, se utilizaron palabras clave con el fin de realizar una búsqueda estandarizada de información y se incluyeron artículos como productos de investigaciones, revisiones sistemáticas, metaanálisis. Las gestantes consumidoras de cocaína entrañan un factor de riesgo para la salud pública, con consecuencias físicas, psicológicas, familiares, sociales para la madre, el neonato y el infante, tales como hipertensión gestacional, desprendimiento de placenta, retardo del crecimiento intrauterino y síndrome de abstinencia neonatal. Es necesario que los profesionales de salud, las instituciones hospitalarias y Secretarías locales de salud elaboren, adapten y adopten algún protocolo de notificación, manejo y seguimiento a las madres consumidoras y de sus hijos para promover hábitos saludables, prevención de complicaciones obstétricas, neonatales y seguimiento de repercusiones en el desarrollo y crecimiento de los hijos.

Latin America reported the following data regarding substance abuse in pregnant women: 44% alcohol, 51.8% tobacco, 8.3% amphetamines, 2.5% cocaine and 2% cannabis. Pregnant women using these substances are a risk factor for health institutions due to the physical, psychological, social, and family consequences for the mother and the newborn infant. Thus, intersectoral and interdisciplinary interventions are necessary to treat this problem. This review describes the physical and behavioral complications in the mother, fetus, and neonate as a result of the use of cocaine and its derivatives during pregnancy. A narrative review was performed by means of a search of journals indexed in PubMed, Lilacs, Ovid, Science Direct from 2000 to 2015. Keywords were used in order to perform a standardized literature search, and data from research articles, systematic reviews, meta-analyses were included. Pregnant consumers of cocaine involve a risk factor for public health due to the physical, psychological, family, and social consequences for the mother, the newborn, and infant, such as high blood pressure, abruption, intrauterine growth retardation, and neonatal abstinence syndrome. It is necessary for local health departments to develop, adopt, and adapt reporting, management, and monitoring protocols for consuming mothers and their children in order to promote healthy habits, prevention of obstetrics and neonatal complications and to monitor the impact on growth and development in children.

Latino-américa reporta nas gestantes um consumo de álcool de 44%, cigarro 51.8%, anfetaminas 8.3%, cocaína 2.5% e maconha 2%. As gestantes consumidoras representam um problema para as instituições prestadoras de saúde que exige intervenções inter-setoriais e interdisciplinares pelas consequências físicas, psicológicas, familiares e sociais que implica para a mãe, o neonato e o infante. Nesta revisão se descrevem as complicações físicas e de condutas na mãe, o feto e o neonato, que surgem pelo consumo de cocaína e seus derivados durante a gestação. Se realizou uma revisão narrativa a partir da busca de informação científica indexada nas bases de dados Pubmed, Lilacs, Ovid, Science Direct entre 2000 e 2015, se utilizaram palavras chave com o fim de realizar uma busca padrão de informação e se incluíram artigos como produtos de investigações, revisões sistemáticas, meta-análise. As gestantes consumidoras de cocaína entranham um fator de risco para a saúde pública, com consequências físicas, psicológicas, familiares, sociais para a mãe, o neonato e o infante, tais como hipertensão gestacional, desprendimento de placenta, retardo do crescimento intrauterino e síndrome de abstinência neonatal. É necessário que os profissionais de saúde, as instituições hospitalares e Secretarias locais de saúde elaborem, adaptem e adotem algum protocolo de notificação, manejo e seguimento às mães consumidoras e de seus filhos para promover hábitos saudáveis, prevenção de complicações obstétricas, neonatais e seguimento de repercussões no desenvolvimento e crescimento dos filhos.

Manifestações do uso de maconha e opiáceos durante a gravidez / Outcomes of marijuana and opioids use during pregnancy

Visando a analisar o uso de maconha e opiáceos durante a gestação e suas consequências, tanto na formação como no futuro desenvolvimento da criança, realizou-se uma revisão crítica da literatura, com foco nos efeitos deletérios dessas drogas no recém-nato. Muitas dúvidas ainda não foram sanadas referentes à ação das drogas e o reflexo no concepto. Foram observadas coincidências entre o uso de maconha e o mau desenvolvimento do tubo neural do recém-nato, além de possíveis anencefalias. Em relação à ação dos opiáceos durante a gestação, foi observado um maior número de partos prematuros, bebês nascidos com baixo peso, com menor circunferência craniana e menor estatura

Aiming at analyzing the marijuana and opioids use during pregnancy and their consequences both in formation and in the future development of the child, a critic review of the literature was carried out focusing on the deleterious effects of these drugs in the recent born. Many questions have not been answered referring to the action of the drug and its reflection on the concept. It had been observed a relationship between use of marijuana and the poor development of the neural tube of the newly born and possible anencephalies. In relation to the opioids outcomes during pregnancy, an increase of premature births, babies born with low-birth weight, small cephalic circumference, and lower height were observed

Articulos originales: hipernatremia neonatal: factores de riesgo / Original articles: neonatal hypernatremia: risk factors

Determinar los factores de riesgo relacionados con la hipernatremia neonatal.

Neonatal abstinence syndrome.

OBJECTIVE: To study the substance misuse in pregnant mothers and its impact on their newborns. METHODS: Case note review of the study population was undertaken. Infants of mothers who had taken substance of misuse were monitored regularly using Finnegan's score and treatment initiated based on a pre-existing protocol. The parameters that were studied included maternal drug habits, antenatal problems, and neonatal epidemiology with particular reference to growth, neonatal abstinence syndrome (NAS), its severity and management. RESULTS: Out of 32 neonates, 28 had developed neonatal withdrawal requiring treatment. The earliest presentation of NAS was at six hours and the average time of presentation of NAS was 26 hours. The dose of methadone taken by the mother related well with the likelihood of development of NAS. The most common symptoms noted at the time of diagnosis were irritable cry, increased tone, tachypnea, sleeplessness and tremor. CONCLUSION: Majority of neonates born to mothers on methadone exhibit neonatal abstinence syndrome and require pharmacological treatment. Neonates who had not exhibited symptoms of drug withdrawal within the first 3 days of life are unlikely to present with NAS requiring treatment.

Maternal and Neonatal Effects of Substance Abuse during Pregnancy: Our Ten-year Experience

PURPOSE: The aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country. MATERIALS AND METHODS: Data on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997-2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group. RESULTS: During the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score < or = 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers. CONCLUSION: Addiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

Fluoxetine withdrawal syndrome in the newborn.

A term baby was admitted to our neonatal unit with jitteriness, hypertonia, sneezing and fever. Her mother was on 20 mg of fluoxetine throughout her pregnancy. These symptoms which were possibly due to fluoxetine withdrawal lasted only for a short while. We attempt to look at the reported prevalence of this condition in the literature.

Perinatal effects of amphetamine and heroin use during pregnancy on the mother and infant.

OBJECTIVES: To determine the perinatal impacts of heroin and amphetamine on both mothers and infants. MATERIAL AND METHOD: This is a retrospective study on the influence of amphetamine and heroin on pregnant women and their newborn infants at King Chulalongkorn Memorial Hospital in Bangkok, Thailand, between January 1997 and December 2002. The medical and demographic data of both mothers and infants were evaluated. Comparison of the consistent drug effects of these 2 drugs on the mothers and infants were also performed RESULTS: Two hundred and eleven women were identified There were 178 (84.4%) and 33 (15.6%) women addicted to amphetamine and heroin respectively. Sixty one (28.9%) of them were polydrug users. There were more polydrug users among heroin addicts than amphetamine addicts, (43.7% vs 27.2%, p < 0.05). Poor obstetric history were noted in both groups of women including lack of prenatal care (74.9%), a high incidence of previous abortion (22.3%), positive HIV serology test (11.1%), pre-eclampsia (5.2%), infection (3.3%) and antepartum hemorrhage (1.9%). Drug intoxication was found in 11 amphetamine addicted mothers, whereas 2 heroin addicts developed withdrawal symptoms during intrapartum and postpartum periods. All infants were singleton. There was one stillbirth and 2 neonatal deaths. There was no statistical difference in terms of sex ratio, mean birth weight, gestational age, length, head circumference and Apgar score between the groups of amphetamine and heroin exposed infants. The incidence of prematurity, low birth weight, IUGR and microcephaly were not statistically different between both groups of infants. The overall incidence was 31.7%, 31.7%, 9.5% and 8.6% respectively. Congenital anomalies were found in 5 (2.8%) amphetamine exposed infants. Thirty one out of 33 heroin exposed infants (93.9%) and 4 out of 178 amphetamine exposed infants (2.2%) developed drug withdrawal symptoms with the mean onset of 21.5 +/- 16.5 hours and 10.3 +/- 7.5 hours respectively, p > 0.05. All heroin withdrawal infants were successfully treated with Phenobarbital with the mean duration of treatment of 23.7 +/- 11.5 days. None of the amphetamine withdrawal infants needed specific treatment. They recovered spontaneously within 6.0 +/- 5.3 days. Eighteen infants were left in an orphanage or under the custody of their relatives. CONCLUSION: Amphetamine or heroin use during pregnancy can cause many serious adverse effects on both mothers and infants. The findings in the present study are consistent with previous reports, although they seemed to be more common and severe. Increasing awareness and improving understanding of drug abuse in the medical, legal and social aspects are needed in order to reduce these impacts.

Methamphetamine abuse during pregnancy and its health impact on neonates born at Siriraj Hospital, Bangkok, Thailand.

To ascertain the impact of intrauterine methamphetamine exposure on the overall health of newborn infants at Siriraj Hospital, Bangkok, Thailand, birth records of somatic growth parameters and neonatal withdrawal symptoms of 47 infants born to methamphetamine-abusing women during January 2001 to December 2001 were compared to 49 newborns whose mothers did not use methamphetamines during pregnancy. The data on somatic growth was analyzed using linear regression and multiple linear regression. The association between methamphetamine use and withdrawal symptoms was analyzed using the chi-square. Home visitation and maternal interview records were reviewed in order to assess for child-rearing attitude, and psychosocial parameters. Infants of methamphetamine-abusing mothers were found to have a significantly smaller gestational age-adjusted head circumference (regression coefficient = -1.458, p < 0.001) and birth weight (regression coefficient = -217.9, p < or = 0.001) measurements. Methamphetamine exposure was also associated with symptoms of agitation (5/47), vomiting (11/47) and tachypnea (12/47) when compared to the non-exposed group (p < 0r =0.001). Maternal interviews were conducted in 23 cases and showed that: 96% of the cases had inadequate prenatal care (<5 visits), 48% had at least one parent involved in prostitution, 39% of the mothers were unwilling to take their children home, and government or non-government support were provided in only 30% of the cases. In-utero methamphetamine exposure has been shown to adversely effect somatic growth of newborns and cause a variety of withdrawal-like symptoms. These infants are also psychosocially disadvantaged and are at greater risk for abuse and neglect.

Maternal substance abuse.

The epidemic of substance abuse, which has swept through much of the world, has left behind a trail of devastated lives and families. Alcohol and substance abuse by women during pregnancy has also been reported to be widespread and can affect the unborn fetus with the potential for life-long disabilities. While the magnitude of the perinatal substance abuse has been the focus of much discussion in the West, the problem is greatly underestimated in other parts of the world. In this article, the author has focused on five highly-abused substances and explored the effects of the drugs on the fetus and the newborn. There is a constant need for evaluating the epidemiology and the consequences of perinatal substance abuse so that health programs can target measures to eliminate the preventable morbidity that results from this practice.

Comportamiento neurológico del recién nacido de madre consumidora de basuco durante su gestación / Effect of maternal consumption of cocaine base paste on neurological behavior of newborn infants

Se estudiaron 20 niños recién nacidos, hijos de madres consumidoras de pasta base de coca (basuco), en comparación con 19 controles nacidos de madres no consumidoras, con el fin de detectar en los primeros alteraciones neurológicas y evidencias de supresión; se hallaron las siguientes con frecuencias significativamente mayores en los hijos de madres consumidoras: temblor (p: 0.00001), irritabilidad (p: 0.0015), náuseas (p: 0.003), llanto deprimido (p: 0.004) y succión deprimida (p:0.02); en los restantes signos de supresión (vómito, anorexia, hipersomnia, hiposomnia, hipertonía, cólico y diarrea) y alteraciones neurológicas

Twenty newborn infants from mothers that consumed coca leaves' paste during pregnancy were compared with 19 controls as to their neurological behavior and supression evidences; the following alterations were significantly more frequent (p < 0.05) in infants from consumer mothers: Tremor, irritability, nausea, and depression of crying, suction and prension. The duration of these alterations as well as that of other neurological abnormalities was significantly longer in infants from consumer mothers. These findings reveal that neonates exposed to cocaine because their mothers consumed coca leaves' paste during pregnancy, reveal neurologic alterations as well as suppression signs that sugest a direct and lasting effect of the drug on their central nervous systems; these infants constitute a serious public health problem whose management requires decision and solid knowledge on its repercusions

The offspring of epileptic mother.

The offspring of an epileptic mother is an issue-currently getting attention because of its several implications. A complex interaction between epilepsy during pregnancy and its adverse impact on foetus, labor, neonate, congenital malformation, psychosocial and medico-social concern and treatment challenges of such cases is increasingly being realised. Some of the significant observations has been reviewed extensively in this article. Maternal epilepsy is likely to adversely affect the off-spring at its various stages of development amounting to increased morbidity and mortality. Increased seizure frequency during pregnancy with resultant increased risk is well documented but its mechanism is poorly understood. Low apgar score, increased still birth rates (1.3 to 14%) in offspring of epileptic mother (OEM) is reported. So also, the neonatal and perinatal deaths are twice more common in OEMS than normal control. Small for dates, and prematurity in OEM is reported to be 7 to 10% and 4-11% respectively. Adverse impact on labor and delivery like preclampsia, abruptio placentae, polyhydramnios, assisted delivery, cesarean section and IUGR poses particular challenges to the obstetrician. Pediatrician's alertness is needed to anticipate and deal with the bleeding manifestation due to deficiency of Vit-K dependent clotting factors and various anticonvulsant drug (AED) withdrawal symptoms. Significant risk of developing congenital malformation is the result of epilepsy perse and the AED used during pregnancy. AED exposure leads to other distinct clinical syndromes, the orofacial clefts and cardiac anomalies being the commonest manifestation. Epilepsy in mother but not in father has significant adverse impact. Management strategies in the context of available observation has been discussed.