Benign neonatal sleep myoclonus in newborn infants of opioid dependent mothers.

OBJECTIVE: The aim of our study was to evaluate the incidence, duration and risk factors for benign neonatal sleep myoclonus (BNSM) in infants with neonatal abstinence syndrome (NAS) treated with opioids or sedatives, compared with control infants. METHODS: This is a single centre observational case control study. Seventy-eight near term and term infants with neonatal opiate abstinence syndrome confirmed by meconium analysis were included. Exclusion criteria were cerebral malformation, intracranial haemorrhage and perinatal asphyxia. The babies were assessed eight hourly with a modified Finnegan score that included sleep myoclonus. Seventy-eight infants not exposed to opiates during pregnancy, hospitalized for at least 14 days and matched for gestational age were used as controls. RESULTS: The median gestational age was 38 (1)/(7) (95% CI: 35 (3)/(7)-41 (2)/(7)) weeks, birth weight 2730 (95% CI: 1890-3600) g, umbilical artery pH 7.25 (CI 7.10-7.37) and Apgar score at 5 minutes 9 (95% CI: 7-10). The control infants did not differ in these characteristics. Sleep myoclonus was diagnosed in 52 (67%) of the infants with NAS and 2 (2.6%) of the controls (OR 26 [95% CI: 7-223], p < 0.001). Myoclonus appeared as early as day 2 and as late as day 56 of life (median day 6) and lasted for 1 to 93 days (median 13 days). All infants had serum glucose > 2.5 mmol/L at first occurrence. The neurological examinations as well as cerebral ultrasound scans were normal. An electroencephalogram (EEG) carried out in 18 infants showed no signs of epileptic activity. CONCLUSION: BNSM has a high incidence in infants with NAS. The diagnosis can be made clinically. In the absence of other neurological symptoms further investigations such as EEG are not necessary and anticonvulsive treatment is not indicated.

The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial.

OBJECTIVE: Our goal was to investigate the effect of placentofetal transfusion on cerebral oxygenation in preterm infants by near-infrared spectroscopy. SUBJECTS: A total of 39 preterm infants with a median gestational age of 30.4 weeks were randomly assigned to an experiment group (n = 15) and a control group (n = 24). INTERVENTIONS: The delivery of the infants in the experiment group was immediately followed by maternal administration of syntocinon, the infant was placed 15 cm below the placenta, and cord clamping was delayed by 60 to 90 seconds. The infants in the control group were delivered conventionally. At the ages of 4 and 24 hours, cerebral hemoglobin concentrations, cerebral blood volume, and regional tissue oxygenation were measured by near-infrared spectroscopy. RESULTS: Cerebral blood volume was not different between the 2 groups at the age of 4 hours (6.1 vs 5.8 mL/100 g of tissue) nor at the age of 24 hours (6.2 vs 6.2 mL/100 g of tissue). Mean regional tissue oxygenation of the experiment group was higher at the ages of 4 hours (69.9% vs 65.5%) and of 24 hours (71.3% vs 68.1%). CONCLUSION: Delayed clamping of the umbilical cord improves cerebral oxygenation in preterm infants in the first 24 hours.

Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources.

BACKGROUND: The aim of the study was to analyze the neonatal impact of a methadone maintenance program in pregnancy, and the social resources of the families involved. METHODS: Descriptive analysis of neonatal data in live births after 24 weeks of gestation in pregnant women enrolled in a methadone maintenance program. The data of 86 babies were analyzed. RESULTS: Median gestational age was 38 (0)/(7) (31-41) weeks; 21 babies (24%) were premature. Median birthweight was 2662 (1340-4050) g; 27% of babies were growth retarded (<3rd centile), and 13% had microcephaly (<3rd centile). Sixty-two percent developed abstinence syndrome requiring pharmacological treatment for a median 47 days. Child Protective Services (CPS) were involved in 56% of cases, and 42% of newborns required placement outside the mother's home. CONCLUSIONS: Babies born to women on methadone had a fourfold higher incidence of prematurity, a ninefold higher incidence of intrauterine growth retardation (IUGR), and a fourfold higher incidence of microcephaly compared with the normal population. Sixty-two percent required pharmacological treatment for abstinence syndrome and 42% required placement.