HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2016, 18, N5 (pages: 43 - 48)

Diagnosis of Neonatal Abstinence Syndrome: Substance Use During Pregnancy

Thomas J. and Wolff K.

Summary: Introduction: Internationally the misuse of prescribed medications is becoming a significant public health problem. The misuse of opioid analgesics is especially problematic with their use in pregnancy a growing but under reported problem. The Case: A male neonate (3.485 kg) suffered poor feeding, gastro-intestinal disturbance, hypoglycaemia, and respiratory distress. During pregnancy his mother was prescribed a variety of psychoactive medications including an opiate analgesic (co-codamol), an antidepressant (citalopram), an antipsychotic (chlorpromazine) and a benzodiazepine receptor agonist (zolpidem). A diagnosis of Neonatal Abstinence Syndrome (NAS) was made following a postnatal disclosure of unquantified maternal tramadol misuse in pregnancy. Conclusions: It is important to recognise the risk of prescribed medication misuse during pregnancy and the impact these drugs may have on the fetus and neonate. A NAS following intrauterine exposure to opioid analgesics has been described clearly in the literature but evidence is limited to case studies and case series. The management of these neonates should include a full maternal medication history, supported by neonatal toxicology, with an applied understanding of the potential neonatal consequences of different intrauterine medication exposures.