Growth and developmental outcome of infants with in-utero exposure to methadone vs buprenorphine.

OBJECTIVE: To compare early growth and developmental outcome of infants with in-utero exposure to low-dose methadone (<100 mg per day), high-dose methadone (⩾100 mg per day) and buprenorphine. STUDY DESIGN: A retrospective review of infants with in-utero methadone and buprenorphine exposure who were evaluated at the Southcoast Developmental Pediatric clinic in New Bedford, MA, USA was completed. Growth data and developmental testing results during infancy were compared among the groups. RESULT: Infants in the high-dose methadone group had lower head circumference z scores and a lower mean score on the Alberta Infant Motor Scale (AIMS). Regression results confirmed an association between methadone dose and head circumference z score and AIMS score. CONCLUSION: Exposure to maternal methadone dose in excess of 100 mg is associated with a reduction in infant head circumference when compared with buprenorphine or lower dose methadone, and may have a negative impact on motor skill development during early infancy.

Clinical characteristics of central European and North American samples of pregnant women screened for opioid agonist treatment.

BACKGROUND: Little comparable information is available regarding clinical characteristics of opioid-dependent women from different countries. In the present study, women from the USA, Canada and a Central European country, Austria, screened for participation in the Maternal Opioid Treatment Human Experimental Research study, were compared with respect to their demographic and addiction histories. METHODS: Pregnant women (n = 1,074) were screened for study participation using uniformed clinical criteria and instruments. The screening results were compared with regard to exclusion, demographics, drug use, and psychosocial and treatment histories. RESULTS: Compared to the screened US and Canadian women, Austrian women were more likely to be younger (p < 0.001), white (p < 0.001), had significantly lower levels of educational attainment (p < 0.001), were less likely to use opioids daily (p < 0.001) and more likely to have been prescribed buprenorphine (p < 0.001). Compared to both rural and urban US groups, the Austrian group was less likely to have legal issues (p < 0.001) and was younger when first prescribed agonist medication (p < 0.001). CONCLUSION: The differences between North American and European groups may offer unique insights concerning treatment and pregnancy outcomes for opioid-dependent pregnant women.

Smoking in pregnant women screened for an opioid agonist medication study compared to related pregnant and non-pregnant patient samples.

BACKGROUND: Little is known about the prevalence and severity of smoking in pregnant opioid dependent patients. OBJECTIVES: To first characterize the prevalence and severity of smoking in pregnant patients screened for a randomized controlled trial, Maternal Opioid Treatment: Human Experimental Research (MOTHER), comparing two agonist medications; and second, to compare the MOTHER screening sample to published samples of other pregnant and/or patients with substances use disorders. METHODS: Pregnant women (N = 108) screened for entry into an agonist medication comparison study were retrospectively compared on smoking variables to samples of pregnant methadone-maintained patients (N = 50), pregnant opioid or cocaine dependent patients (N = 240), non-pregnant methadone-maintained women (N = 75), and pregnant non-drug-addicted patients (N = 1,516). RESULTS: Of screened patients, 88% (n = 95) smoked for a mean of 140 months (SD = 79.0) starting at a mean age of 14 (SD = 3.5). This rate was similar to substance use disordered patients and significantly higher compared to general pregnant patients (88% vs. 22%, p < .001). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Aggressive efforts are needed to reduce/eliminate smoking in substance-abusing pregnant women.

Neurobehavioral effects of treatment for opiate withdrawal.

A partially randomised, controlled trial was performed to test the hypothesis that opiate exposed infants treated with diluted tincture of opium (DTO) and phenobarbital would have better neurobehavioral scores than infants treated with DTO alone. Compared with those treated with DTO alone (n = 15), infants treated with DTO and phenobarbital (n = 17) were more interactive, had smoother movements, were easier to handle, and less stressed. Dual treatment results in improved neurobehavioral organisation during the first three weeks of life, which may indicate a more rapid recovery from opiate withdrawal.

Effects of indomethacin on brain blood flow, cerebral metabolism, and sagittal sinus prostanoids after hypoxia.

We tested the hypotheses that during recovery from hypoxia, newborn piglets exhibit a posthypoxic cerebral hyperemia, indomethacin-pretreated piglets exhibit a posthypoxic cerebral hypoperfusion, and that the changes caused by indomethacin are dose dependent and related to the loss of prostanoids. We studied piglets exposed to 40 min of hypoxia after pretreatment with high (5 mg/kg, n = 9) or low (0.3 mg/kg, n = 8) doses of indomethacin or placebo (n = 9) and allowed to recover for 120 min. In the placebo and low-dose pretreatment groups, total and regional brain blood flow increased during hypoxia but returned to baseline 10 min after hypoxia. High-dose indomethacin pretreatment was associated with a posthypoxic hypoperfusion to certain brain regions at 10 min of recovery to values similar to those after indomethacin treatment before the onset of hypoxia. During and after hypoxia, the cerebral metabolic rate of oxygen was preserved in both the placebo and low-dose groups and decreased significantly during hypoxia in the high-dose group. Sagittal sinus prostacyclin was reduced significantly in both indomethacin-treated groups throughout the study. We conclude that a posthypoxic hyperemia is not observed in newborn piglets. This finding was not altered by pretreatment with a therapeutic dose of indomethacin, whereas a pharmacological dose was associated with selective hypoperfusion to certain brain regions both before hypoxia and during recovery from hypoxia.

Use of pulse oximetry to monitor venous saturation during extracorporeal life support.

OBJECTIVE: To assess the ability of two different pulse oximeters to display continuous venous oxygen saturation through an extracorporeal bypass circuit with a degree of accuracy comparable to direct in-line oximetry. DESIGN: Prospective, comparison study of pulse oximeters (test oximeter 1 or test oximeter 2) and an in-line oximeter (test oximeter 3). SETTING: A tertiary care neonatal intensive care unit. PATIENTS: Sixty-five consecutive neonates with severe cardiorespiratory failure undergoing extracorporeal life support. INTERVENTIONS: The accuracy of the oximeters was determined by simultaneously comparing the saturation displayed by the pulse oximeters (test oximeters 1 and 2) and/or the in-line oximeter (test oximeter 3) with the measured fractional venous oxygen saturation obtained at regular intervals from the extracorporeal circuit. MAIN OUTCOME MEASURES: Venous oxygen saturation was the criterion standard used to determine accuracy. Bias was defined as the mean difference between observed pulse oximeter or in-line oximeter values and the measured venous oxygen saturation. Mean biases were calculated for venous oxygen saturation measurements between 55% and 99% at intervals of 10%. Precision (the standard deviation of the bias) was calculated for low (55% to 75%), medium (76% to 81%), and high (82% to 99%) venous oxygen saturation values. A total of 983 venous oxygen saturation measurements were made and compared with simultaneous oximeter readings from test oximeter 1 (n = 600), test oximeter 2 (n = 478), and test oximeter 3 (n = 587). RESULTS: Test oximeter 1 was the most precise instrument at each level of venous oxygen saturation (SD, 4.0 to 4.8). Test oximeter 3 demonstrated the most consistent mean bias (range, 8), but was the most inaccurate oximeter across all levels of venous oxygen saturation. CONCLUSIONS: In addition to its known clinical usefulness, pulse oximetry may serve as an adequate substitute for in-line oximetry during extracorporeal life support.

Effects of indomethacin on brain blood flow and cerebral metabolism in hypoxic newborn piglets.

We tested the hypotheses that in newborn piglets indomethacin (Indo) pretreatment blunts the hyperemic brain blood flow (BF) and alters the cerebral metabolic responses to hypoxia and that these responses are dose dependent. We studied 23 chronically instrumented piglets exposed to graded hypoxia (O2 content: 7.1-0.4 microM O2/ml) after pretreatment with high (5 mg/kg, n = 8)-or low (0.3 mg/kg, n = 6)-dose Indo or placebo (diluent, n = 9). Total and regional brain BF increased significantly with decreasing O2 content values (P < 0.01) in all three groups. However, the rise in the brain BF curves with decreasing O2 content values was significantly (P < 0.05) lower in the high-compared with the low-dose group in all brain regions with the greatest effect in the caudal regions. Furthermore, the BF curves in the placebo-treated animals were similar to the low-dose group. The cerebral metabolic rate of O2 (CMR(O2)) and glucose metabolism were preserved in the three groups over all hypoxic ranges until severe hypoxia (O2 content < or = 1.1 microM O2/ml) was achieved in the high-dose group, when CMR(O2) decreased (P < 0.05), and glucose metabolism increased (P < 0.05). The mean arterial blood pressure in the high-dose group during severe hypoxia was 45 mmHg (P > 0.05). Although coupling of cerebral BF and CMR(O2) was preserved in the three groups, this association was significantly altered with high-dose pretreatment. We conclude that an attenuation in the hypoxia-induced brain perfusion by Indo is dose dependent. Alterations in CMR(O2) and glucose metabolism are observed with high-dose pretreatment during severe hypoxia, and the responses to hypoxia are similar with placebo and low-dose Indo pretreatment.

Rapid analysis of pregnanediol in pregnancy urine.

A simple, inexpensive, and rapid method for the determination of pregnanediol in pregnancy urine by gas liquid chromatography is described. Automatic injection of the samples into the gas chromatograph allows up to 36 samples to be run overnight thus saving valuable technical time.The method described can easily be adopted for use in a routine steroid laboratory. The results obtained by this method have been compared with values obtained by the method of Klopper, Michie, and Brown (1955).