Social service robots to support independent living : Experiences from a field trial.

BACKGROUND: Assistive robots could be a future means to support independent living for seniors. OBJECTIVE: This article provides insights into the latest developments in social service robots (SSR) based on the recently finished HOBBIT project. The idea of the HOBBIT project was to develop a low-cost SSR which is able to reduce the risk of falling, to detect falls and handle emergencies in private homes. The main objective of the project was to raise the technology to a level that allows the robot to be fully autonomously deployed in the private homes of older users and to evaluate technology market readiness, utility, usability and affordability under real-world conditions. METHOD: During the initial phase of the project, a first prototype (PT1) was developed. The results of laboratory tests with PT1 were used for the development of a second prototype (PT2), which was finally tested in seven households of senior adults (mean age 79 years) for 3 weeks each, i.e. in total more than 5 months. RESULTS: The results showed that PT2 is intuitive to handle and that the functions offered meet the needs of older users; however, the robot was considered more as a toy than a supportive device for independent living. Furthermore, despite an emergency function of the robot, perceived security did not increase. CONCLUSION: Reasons for this might be a lack of technological robustness and slow performance of the prototype and also the good health conditions of the users; however, users believed that a market-ready version of the robot would be vital for supporting people who are more fragile and more socially isolated. Thus, SSRs have the potential to support independent living of older people although the technology has to be considerably improved to reach market readiness.

Management of hypothermia for perinatal asphyxia in Austria - a survey of current practice standards.

BACKGROUND: Therapeutic hypothermia (HT) has been shown to reduce the risk of death or disability and increase the rate of survival free of -disability at 18-24 months of age in hypoxic-ischemic encephalopathy (HIE). OBJECTIVES: The aim of this study was to take a national survey which (a) evaluated the practice of therapeutic HT for perinatal asphyxia in Austria, (b) evaluated the current clinical management of neonatal HIE and (c) evaluated the need for a national perinatal asphyxia and HT registry. METHODS: In January 2013, a questionnaire was sent out to the clinical heads of all neonatal level-II and level-III units in Austria. RESULTS: We received replies from all 30 level II and level III units in Austria (response rate 100%). 19 units (63%) answered that they applied HT, 11 units (37%) said they transferred patients for cooling to other units, 3 of those 11 units (27%) said they applied cooling during transport. 25 units (83%) felt the necessity to establish a national registry. CONCLUSION: The results of this survey show that there is already a high implementation of therapeutic HT in Austria, but there remains a need for information, awareness and training. Problem areas tend to be in the transport of asphyxiated neonates, brain monitoring during cooling and follow-up of affected patients. We believe, that the establishment of national guidelines and a national register could increase awareness for the importance of therapeutic HT in neonatal HIE, thus improve the Austrian management of those infants.

Decompressing posthaemorrhagic ventricular dilatation significantly improves regional cerebral oxygen saturation in preterm infants.

AIM: This study aimed to delineate the impact of posthaemorrhagic ventricular dilatation (PHVD) on regional cerebral oxygen saturation (rcSO2) in preterm infants before and after ventricular decompression using near-infrared spectroscopy (NIRS). METHODS: rcSO2 values were recorded, fractional tissue oxygen extraction (FTOE) was calculated, cerebral ultrasound scans were performed, and resistive indices and ventricular width were collected before and after decompression. Where possible, amplitude-integrated electroencephalography (aEEG) and visual evoked potentials (VEPs) were recorded before and after decompression. RESULTS: We included nine preterm infants: nine with cranial ultrasound scan data, eight with NIRS data, seven with aEEG data and four with VEPs. The resistive index was stable and remained unchanged after decompression in all patients. Before decompression, the mean rcSO2 value was 42.6 ± 12.9% and increased to 55 ± 12.2% after decompression. With increasing ventricular width, FTOE showed a mean value of 0.51 ± 0.05 and decreased to a mean of 0.39 ± 0.12 after decompression. Amplitude-integrated electroencephalography showed a more continuous pattern, and VEPs showed delayed latencies in all patients before intervention, improving afterwards. CONCLUSION: Near-infrared spectroscopy may be of additional clinical value in progressive PHVD to determine the optimal time point for ventricular decompression.

Neonatal abstinence syndrome in European and North American neonates: differences in clinical characteristics derived from a prospective randomized trial.

BACKGROUND: Due to the steady increase of substance-dependent pregnant women the neonatal abstinence syndrome has become an increasingly important issue in neonatology. The present study investigates site-specific differences of detailed symptoms and treatment of neonatal abstinence syndrome within the context of an international multicenter clinical trial. METHODS: Site specific neonatal data analyses from a prospective randomized, double-blind, double-dummy clinical trial (MOTHER study) was performed. A standardized NAS rating and treatment protocol was applied, while non-pharmacological care of NAS symptoms differed across the sites. RESULTS: Urban US neonates exhibited most neurological symptoms (p<0.001) while in Europe autonomous, respiratory and gastrointestinal symptoms were found significantly more often compared to urban and/or rural US (p<0.05). Methadone produced significantly greater scores than buprenorphine in neurological, behavioural and respiratory symptoms regardless of the sites (ps<0.05). NAS treatment rates in all site clusters were similar for methadone-exposed neonates, while in Europe significantly more buprenorphine-exposed neonates were treated (p=0.001) than in US site clusters. Urban US neonates had significantly higher NAS scores (p<0.01) compared to rural US and European neonates, and needed significantly higher morphine doses (p<0.05) with longer treatment duration. Birth weight, length and head circumference did not differ significantly among the site clusters, but APGAR scores were significantly higher in European (p<0.01) neonates. CONCLUSION: In addition to intrauterine medication exposure other aspects such as different addiction severity of the mothers, different treatment modalities including rooming-in as well as the frequency of NAS ratings may be influencing the course of NAS.

Impact of low-grade intraventricular hemorrhage on long-term neurodevelopmental outcome in preterm infants.

PURPOSE: Despite a decreasing incidence, intraventricular hemorrhage (IVH) remains a point of major concern in neonatology due to its association to adverse neurodevelopmental outcome (NDO). Aim of this study was to compare outcome of preterm infants with different grades of IVH born below 32 weeks of gestational age (GA) with outcome of controls without IVH and to especially evaluate the influence of low grade IVH on NDO. METHODS: Four hundred seventy-one preterm infants with a GA below 32 weeks were admitted to our neonatal intensive care unit between 1994 and 2005 and included into analysis. RESULTS: IVH patients showed significantly lower mean psychomotor and mental developmental indices and a significantly higher percentage of cerebral palsy and visual impairment. Results of IVH patients born below 28 weeks of GA were significantly worse than results of IVH patients born at or above 28 weeks of GA. In all parameters, an increase of abnormal results with increasing grade of IVH could be observed; even patients with low-grade IVH (grades I and II) showed higher percentages of impairment compared to controls without any IVH. CONCLUSION: Even low-grade IVH has an significant impact on neurodevelopmental outcome of preterm patients and gestational age influences the impact of intraventricular hemorrhage on neurodevelopmental outcome.

Comparison of neonatal MRI examinations with and without an MR-compatible incubator: advantages in examination feasibility and clinical decision-making.

PURPOSE: To assess the utility of an MRI-compatible incubator (INC) by comparing. METHODS: In a retrospective study, the clinical and radiological aspects of 129 neonatal MRI examinations during a 3 year period were analyzed. Routine protocols including fast spin-echo T2-weighted (w) sequences, axial T1w, Gradient-echo, diffusion sequences, and 3D T1 gradient-echo sequences were performed routinely, angiography and spectroscopy were added in some cases. Diffusion-tensor imaging was done in 50% of the babies examined in the INC and 26% without INC. Sequences, adapted from fetal MR-protocols were done in infants younger than 32 gestational weeks. Benefit from MR-information with respect to further management was evaluated. RESULTS: The number of the examinations increased (30-99), while the mean age (43-38, 8 weeks of gestational age) and weight (3308-2766 g) decreased significantly with the use of the MR-compatible incubator. The mean imaging time (34, 43-30, 29 min) decreased, with a mean of one additionally performed sequence in the INC group. All infants received sedatives according to our anaesthetic protocol preceding imaging, but a repeated dose was never necessary (10% without INC) using the INC. Regarding all cases, MR-based changes in clinical management were initiated in 58%, while in 57% of cases the initial ultrasound diagnosis was changed or further specified. CONCLUSIONS: The use of the INC enables the MR access of unstable infants with suspect CNS problems to the management, of whom is improved by MR information to significantly higher percentage, than without INC.

Effect of the Y-piece of the ventilation circuit on ventilation requirements in extremely low birth weight infants.

OBJECTIVE: Volutrauma caused by high tidal volumes contributes considerably to the development of bronchopulmonary dysplasia. Yet high tidal volumes are required to overcome dead space. In an experimental arrangement we tested whether reduction of dead space might reduce ventilation requirements and thus reduce volutrauma in preterm infants. MATERIALS AND METHODS: The time required to eliminate CO2 by standardized mechanical ventilation from a preterm infant's test lung flooded with CO2 was measured. Four different Y-pieces and flow sensor combinations were tested with and without a device for closed suction: Y-piece without flow sensor; integrated flow sensor; small dead-space flow sensor; and a new dead-space free-flow sensor for preterm infants. CO2 concentrations were measured by a capnograph. Mean CO2 elimination times (+/-SD) were compared. RESULTS: Mean CO2 elimination time was 37.5 s (+/-1.18 s) with and 37.4 s (+/-0.97 s) without closed suction device for the Y-piece without flow sensor, 47.7 s (+/-0.82 s) and 45.5 s (+/-1.18 s) for the integrated flow sensor, 42.5 s (+/-1.27 s) and 41.1 s (+/-0.99 s) for the small dead-space flow sensor and 38.3 s (+/-1.16 s) and 36.8 s (+/-0.79 s) for the dead-space free-flow sensor. CONCLUSION: CO2 elimination time with and without closed suction device was nearly identical for the Y-piece without flow sensor and for the dead-space free-flow sensor. With both systems, ventilation requirements were significantly lower than for the integrated flow sensor and for the small dead-space flow sensor (integrated flow sensor vs dead-space free-flow sensor 23.6 and 24.5%, respectively, small dead-space flow sensor vs dead-space free flow sensor 11.7 and 10.9%, respectively); thus, we think that introduction of the innovative dead-space free-flow sensor into clinical practice might reduce incidence and severity of bronchopulmonary dysplasia by reduction of volutrauma.

The clinical impact of magnetic resonance imaging in fetuses with central nervous system anomalies on ultrasound scan.

OBJECTIVES: Magnetic resonance imaging (MRI) was performed on fetuses with sonographically diagnosed central nervous system (CNS) anomalies to determine frequency and type of cases in which fetal MRI adds clinically relevant information. PATIENTS AND METHODS: Forty-three cases presenting with CNS anomalies by ultrasonography were investigated by MRI. The potential effect of MRI on parental counseling and pre- or postnatal management were the main endpoints. RESULTS: Fetal MRI confirmed the sonographic diagnosis in 28 of 43 cases, showed additional findings in 14 of 43 cases, and was inferior to sonography in 1 of 43 cases. The MRI diagnosis had therapeutic consequences in 11 of 43 patients, with the fetal MRI diagnosis influencing parental counseling in 8 of these 11 patients. Prenatal patient care was not influenced by the additional investigation with fetal MRI. CONCLUSION: MRI is well suited as additional imaging method in fetuses with CNS anomalies. Additional fetal MRI is particularly indicated if the findings might have a therapeutic consequence.

Verification of anomalies of the central nervous system detected by prenatal ultrasound.

OBJECTIVE: The accuracy of fetal ultrasound (US) in diagnosing central nervous system (CNS) malformations was assessed with the aim to define in which cases US is reliable enough to assist in decisions on medical indication for abortions without resorting to magnetic resonance imaging (MRI). DESIGN: Retrospective analysis of the course of 69 fetuses with anomalies of the CNS detected on prenatal US in a university hospital. SETTING: General Hospital of Vienna, University of Vienna, Austria. METHOD: Prenatal US diagnosis was verified by postpartal US, MRI or computed tomography (CT) in the live births, and by autopsy of the fetus in cases of pregnancy termination. RESULTS: Abortion was induced in 40 fetuses for anencephaly (n = 4), exencephaly (n = 6), dorsal dysraphism (n = 6), encephalocele (n = 3), pronounced hydrocephaly (n = 11), holoprosencephaly (n = 4), Dandy Walker cyst (n = 5), and 1 complex syndrome - all confirmed on autopsy. In 29 live births, hydrocephaly, meningomyelocele, and microcephaly had always been correctly identified prenatally. Four Chiari malformations had been missed. Agenesis of the corpus callosum had remained unnoticed in 4 out of 14 cases and been erroneously reported in 5. Diagnostic errors were frequent for Dandy-Walker cyst and great cerebellomedullary cistern. CONCLUSION: Transabdominal fetal US did not lead to unjustified interventions. Inaccuracy in diagnosing abnormalities of the posterior fossa and the median telencephalon as well as aetiological clarification of hydrocephalus require additional MRI of the fetal CNS in patients selected accordingly.

Progressive posthemorrhagic hydrocephalus leads to changes of amplitude-integrated EEG activity in preterm infants.

AIM: Intraventricular hemorrhage (IVH) is the most common cause of brain lesions in preterm infants. Among infants with IVH about 35% develop posthemorrhagic hydrocephalus (PPH) which may lead to secondary injury. Therapeutic interventions to reduce the increased intracranial pressure are invasive and carry a high risk of complications. Amplitude-integrated EEG (aEEG) allows continuous neurophysiological surveillance and may help in defining the optimal timing for intervention in infants with progressive PHH. In this report we show, for the first time, a change in aEEG activity in two preterm infants with PHH. METHODS: Cerebral activity was continuously monitored by aEEG provided by the Cerebral Function Monitor (Lectromed, UK) in two preterm infants with PPH. RESULTS: With increasing ventricular width, aEEG showed an increased discontinuity without distinguishable sleep-wake cycling in both infants. One infant showed an abrupt onset of a nearly isoelectric pattern without any change in clinical condition. Clinical signs of increased intracranial pressure developed 6-12 h later in both children. In one patient, aEEG activity returned to normal after successful shunting and reduction of intracranial pressure. CONCLUSION: Continuous neurophysiological monitoring by aEEG may be of value in the diagnostic and therapeutic management of preterm infants with progressive PHH.

[Opiate addiction in gravidity - consequences for the newborn. Results of an interdisciplinary treatment concept]. / Opiatabhängigkeit in der Schwangerschaft - Konsequenzen für das Neugeborene1 - Ergebnisse eines interdisziplinären Betreuungsmodells -

AIMS: To evaluate the outcome of infants of drug dependent mothers (IDM) after establishing an interdisciplinary attention concept at the University Hospital in Vienna. To compare the influence of different maintenance agents on neonatal morbidity. PATIENTS AND METHODS: All newborns of opiate dependent mothers were prospectively included from III 1995 to IX 1999. The following data were collected: maintenance agent (methadone, slow release morphine, buprenorphine), infectious status, demographic data, congenital malformations, perinatal complications, as well as incidence and duration of the neonatal abstinence syndrome (NAS). Medical treatment with phenobarbital (1995 - 96) or morphine hydrochloride (MoHCl) (1997 - 99), respectively, was indicated when Finnegan score exceeded 10. RESULTS: 88 neonates (38 females/50 males) with a median gestational age of 39 weeks were included, 18 (20.5 %) were born prematurely. The median birthweight was 2905 g, 24 (27.3 %) infants were small for date (< 10th percentile), 15 (17 %) microcephalic. The malformation incidence was 7.4 %. 63 (72 %) of all newborns had to be treated due to abstinence syndrome: in the methadone group 76 %, in the morphine group 93 %, but in the buprenorphine group 19 % only (p < 0.01). Median duration of withdrawal was 15.1 days (d) with significant difference after antenatal buprenorphine exposure compared to methadone and morphine exposure (8.3 d versus 15 d and 16.5 d respectively). In neonates treated with phenobarbital duration of NAS was 17.6 d, whereas NAS in infants with MoHCl therapy lasted 12.8 d (p < 0.05). CONCLUSION: Incidence and duration of NAS after buprenorphine exposure was significantly lower than after methadone and morphine exposure. Withdrawal time under morphin-hydrochloride therapy was reduced by one third compared to treatment with phenobarbital.

Posthemorrhagic hydrocephalus in preterm infants: long-term follow-up and shunt-related complications.

INTRODUCTION: A retrospective analysis of 42 preterm infants with intraventricular hemorrhage was performed in order to evaluate shunt-related problems in neonates with posthemorrhagic hydrocephalus. PATIENTS AND METHODS: Within the last 15 years, 76 infants with intraventricular hemorrhage were treated primarily by external ventricular drainage, and 42 needed permanent shunting. Shunting was performed 28-101 days after the patients' birth, ventriculoatrial shunts being placed in 10 patients and ventriculoperitoneal shunts in 32. RESULTS: The mean number of shunt revisions per patient was 1.57. The main reasons for shunt revision were infection (7.1%) and blockage (45.2%). Primary ventriculoperitoneal and ventriculoatrial shunts differed only insignificantly in revision rate and length of shunt survival, whereas ventriculoperitoneal shunts used in shunt revisions required significantly fewer further revisions. CONCLUSIONS: The neurological outcome was not related to the necessity for or to complications of a shunt. Programmable valve systems and neuroendoscopy appear to be helpful in the overall management and in the treatment of complications.

Evaluation of the Cerebral Function Monitor as a tool for neurophysiological surveillance in neonatal intensive care patients.

BACKGROUND: Cerebral function in critically ill infants is difficult to assess and would certainly require continuous monitoring. Therefore, this study was performed to evaluate the Cerebral Function Monitor (CFM) as a tool for continuous neurophysiological surveillance in the Neonatal Intensive Care Unit (NICU). PATIENTS: A total of 40 neurological risk neonates were included in the study. They were classified on the basis of their primary diagnoses as infants with clinically manifest seizures, suspected seizure activity, intracranial hemorrhage (ICH) and hypoxic-ischemic encephalopathy (HIE). A group of 20 neurologically normal (preterm and full-term) infants served as controls. RESULTS AND CONCLUSION: All patients with seizures showed pathologic patterns in both the CFM and the conventional EEG tracings. The patients with ICH showed depressed amplitudes, an increase in discontinuous activity, and a high incidence of seizure activity. The patients with HIE were characterized by depressed activities correlating with the severity of the pathology. Our results indicate that the CFM is a very helpful tool for neurophysiological surveillance in high-risk neonates.

Perinatal mortality and morbidity. Comparison between maternal transport, neonatal transport and inpatient antenatal treatment.

The purpose was to assess differences in neonatal morbidity and mortality between maternally transferred, neonatally transferred and inborn neonates. We evaluated a continuous series of all antenatal transported infants (ATI, n=247) and postnatal transported infants (PTI, n=34) to the NICU and all preterm inborns (NTI, n=120) delivered at the University Hospital of Vienna. Data collected included sociodemographic, obstetrical and neonatal data. Mild neonatal morbidity was defined as RDS, BPD, ROP, PDA, NEC or IVH I-II, whereas severe neonatal morbidity was defined as the presence of PVL or IVH III-IV. Data were analyzed statistically using the Spearman correlation Coefficient, the Kruskal-Wallis test, and a multivariate model. There was a substantial gain in gestational age from transfer to delivery in the ATI group and from admission to delivery in the NTI group (2.1 and 5.6 weeks, respectively). The neonatal survival rate was 88.7% in the ATI and 97.5% in the NTI group. No neonate died in the PTI group; there was a significantly higher percentage of severe neonatal morbidity than in the ATI group (11.8% vs. 4.9%). We could not observe a significant difference with respect to the risk of death among the three study groups. There was a strong trend towards higher probability of severe neonatal morbidity in the NTI group. The risk of severe neonatal morbidity is much higher in the PTI-group (rel. risk 0.19, 0.06). Antenatal transfer guaranteed a significantly better neonatal outcome concerning severe neonatal morbidity than postnatal transport, and compared favorably with inborn admissions, even given the higher gestational age and birth weight in the NTI-group.

Sleep-wake cycles in preterm infants below 30 weeks of gestational age. Preliminary results of a prospective amplitude-integrated EEG study.

In the newborn, presence of sleep-wake cycles indicates integrity and maturity of the central nervous system. By spectral EEG analysis and polygraphic recordings subtle variations of EEG background activity and behavioural patterns corresponding to early sleep-wake cycles have been found in preterm infants as young as 27 weeks of gestation. The emergence of sleep-wake cycles at early gestational ages may have a positive predictive value for long-term neurological outcome. Sleep-wake cycles and their significance for later outcome have not been studied in very preterm infants so far. Accordingly, we prospectively investigated maturational changes of EEG activity and sleep-wake cycles in preterm infants below 30 weeks of gestational age using the Cerebral Function Monitor, an amplitude-integrated EEG. We present preliminary data on the emergence of sleep-wake cycles in preterm infants from this ongoing study. Of 100 infants enrolled during a 1-year period, 38 infants without neurological complications were included in the reference group. In this group (mean gestational age 27 weeks), we observed cyclical variations of EEG background activity resembling early sleep-wake cycles at a mean gestational age of 28 weeks and a median postnatal age of 6 days. It is hypothesised that these cyclical variations of EEG background activity may represent switches between thalamo-cortical and neo-cortical pattern generators and indicate integrity of central nervous system function. Amplitude-integrated EEG may thus serve as a useful noninvasive test for brain function in preterm infants.

Effect of intravenous iron supplementation on erythropoiesis in erythropoietin-treated premature infants.

OBJECTIVE: To test the efficacy and safety of combining intravenous iron in amounts approximating the in utero iron accretion rate and the postnatal iron loss with erythropoietin (EPO) in very low birth weight (VLBW) infants. METHODS: A prospective, controlled, randomized, unmasked trial lasting 21 days was performed in 29 clinically stable VLBW infants <31 weeks' gestation and <1300 g birth weight not treated with red blood cell transfusions during the study period. Mean (+/- standard error of the mean) age at study entry was 23 +/- 2.9 days. After a 3-day run-in baseline period in which all participants received oral supplements of 9 mg/kg/day of iron polymaltose complex (IPC), participants were randomized to receive 18 days of treatment with: 1) oral IPC alone (oral iron group); 2) 300 U of recombinant human EPO (r-HuEPO) kg/day and daily oral IPC (EPO + oral iron group); 3) 2 mg/kg/day of intravenous iron sucrose, r-HuEPO, and oral iron (intravenous iron + EPO group). To assess efficacy of the 3 treatments, serial blood samples were analyzed for hemoglobin (Hb), hematocrit (Hct), reticulocyte count, red blood cell indices and plasma levels of transferrin, transferrin receptor (TfR), ferritin, and iron. Oxidant injury was assessed before and after treatment by plasma and urine levels of malondialdehyde (MDA) and o-tyrosine. RESULTS: At the end of treatment, Hb, Hct, reticulocyte count, and plasma TfR were markedly higher in both of the EPO-treated groups, compared with the oral iron group. At study exit a trend toward increasing Hb and Hct levels and significantly higher reticulocyte counts were observed in the intravenous iron + EPO group, compared with the EPO + oral iron group. During treatment, plasma ferritin levels increased significantly in the intravenous iron + EPO group and decreased significantly in the other 2 groups. By the end of treatment, ferritin levels were significantly higher in the intravenous iron + EPO group compared with the other 2 groups. Although plasma and urine MDA or o-tyrosine did not differ among the 3 groups, plasma MDA was significantly greater in the subgroup of intravenous iron + EPO participants sampled at the end of the 2-hour parenteral iron infusion, compared with values observed immediately before and after parenteral iron-dosing. CONCLUSIONS: In stable VLBW infants receiving EPO treatment, parenteral supplementation with 2 mg/kg/day of iron sucrose results in a small, but significant, augmentation of erythropoiesis beyond that of r-HuEPO and enteral iron alone. However, to reduce the potential adverse effects of parenteral iron/kg/day on increasing plasma ferritin levels and on causing oxidative injury, we suggest that the parenteral iron dose used should be reduced and/or the time of infusion extended to maintain a serum iron concentration below the total iron-binding capacity.

Outcome of very-low-birth-weight infants at 1 and 2 years of age. The importance of early identification of neurodevelopmental deficits.

The developmental and neurologic outcome of very-low-birth-weight infants (n=76) at 1 and 2 years, corrected for postconceptional age, and variables predicting outcome were assessed. At 1 year 24% of tile children were neurologically normal and at 2 years 61%. Developmental status was evaluated by use of the Griffiths Developmental Scales. The rate of cognitively normal children remained constant (58% at 1 year and 59% at 2 years) indicating that developmental status at 1 year was predictive for the second year. This early period is important, therefore, for the identification of developmental deficits and for establishing early, adequate interventions.

Treatment of opioid-dependent pregnant women with buprenorphine.

AIMS: To assess the maternal and fetal acceptability of buprenorphine and neonatal abstinence syndrome (NAS) in children born to buprenorphine-maintained mothers. DESIGN AND SETTING: Open-label, flexible dosing, inpatient induction with outpatient maintenance, conducted at the University of Vienna within the existing pregnancy and drug addiction program. PARTICIPANTS: Fifteen opioid-dependent pregnant women. INTERVENTION: Sublingual buprenorphine tablets (1-10 mg/day). MEASUREMENTS: Mothers: withdrawal symptoms (Wang Scale), nicotine dependence (Fagerström Scale: FTQ) and urinalysis. Neonates: birth outcome and NAS (Finnegan Scale). FINDINGS: All subjects were opioid-, nicotine- and cannabis-dependent. Buprenorphine was well tolerated during induction (Wang Score < or = 4) and illicit opioid use was negligible (91% opioid-negative). All maternal, fetal and neonatal safety laboratory measures were within normal limits or not of clinical significance. Mean birth outcome measures including gestational age at delivery (39.6 +/- 1.5 weeks), Apgar scores (1 min = 8.9; 5 min = 9.9; and 10 min = 10), birth weight (3049 +/- 346 g), length (49.8 +/- 1.9 cm) and head circumference (34.1 +/- 1.8 cm) were within normal limits. The NAS was absent, mild (without treatment) and moderate (with treatment) in eight, four and three neonates, respectively. The mean duration of NAS was 1.1 days. CONCLUSIONS: Buprenorphine appears to be well accepted by mother and fetus, and associated with a low incidence of NAS. Further investigation of buprenorphine as a maintenance agent for opioid-dependent pregnant women is needed.