About this Research Topic
The research topic entitled “Effects of Perinatal Opioid Exposure” Volume II will highlight information that needs further elucidation and that may have an effect on the development of Neonatal Abstinence
Syndrome (NAS). However, since we have a maternal/infant dyad, it is essential to include significant issues during pregnancy, birth, and postpartum that may influence the onset, progression, severity, and
duration of NAS.
The number of newborns with neonatal abstinence syndrome (NAS), who are born to women using opioids during pregnancy is steadily increasing. Substance Use Disorder (SUD) in pregnancy may occur as
a result of illicit drug use or misuse of prescribed medications for pain. NAS can result from the latter aswell as from medications for opioid use disorder (MOUD) for treatment of SUD in pregnancy. Current
studies describe methods to mitigate occurrence or decrease severity of NAS by using MOUD in divided doses and not daily. Although the term neonatal opioid withdrawal syndrome (NOWS) is referred to by
some investigators, NAS appropriately indicates the manifestations of withdrawal from opioids and often in combination with other substances such as tobacco, benzodiazepines, selective serotonin
inhibitors, barbiturates, methamphetamine, etc. Each of these substances has been reported to be associated with newborn withdrawal signs. In the clinical setting, in pregnancy, most women use more than one drug making NAS a more realistic term.
Manuscripts in Volume I provided a historical perspective on NAS, addressing the changing prevalence of the disorder over the years and the factors that may have contributed to its emergence as a public health problem. The comparison of clinimetric versus psychometric properties of scoring systems was elucidated as applied in clinical settings. Also included in Volume I were the genomics of NAS, the associated disturbances in suck-swallow-breath rhythm, and the electroencephalographic findings consistent with benign sleep myoclonus. Preclinical studies showed the effects of opioids on the developing brain at different stages of development; findings which may explain long-term behavioral effects, thus a basis for behavior teratology.
Recent research has shown that a number of issues during pregnancy can influence several aspects of NAS as well as the health of mother and baby. The importance of comprehensive services to include medical, psychosocial and appropriate protocols for medication treatment have been known and the lack of fragmentation of services is important. Protocols for withdrawal from opioids in pregnancy are available for selected patients and nuances with regard to specific issues during pregnancy should be considered. The mitigation of stress and methadone dosing guidelines are recently recommended. Covid-19 in pregnancy has been shown to cause certain morbidities and recommendations are on-going. Considerable emphasis should be provided on such issues as compassion, language and stigma when treatment is provided during pregnancy. Therefore, Volume II will include the current views on these topics as well as those described below. Important aspects of prenatal opioid exposure which continues to be debated are the diagnosis, assessment, treatment and monitoring of treatment for NAS.
Clinicians from different centers use different methods of assessment of NAS and there are also variations in the number of medications used for pharmacologic treatment. Although there are specific signs and manifestations unique to neonatal opioid withdrawal, there is little information regarding the physiological changes associated
with NAS. Another important area from a neonatal standpoint is the use of opioids for sedation and pain relief in surgical procedures or in Extracorporeal Membrane Oxygenation (ECMO) in newborns with
prenatal opioid exposure. The morbidity and mortality of infants with NAS through the first few months or a year post-discharge should be a major focus for short term outcomes. Addressing outcomes should
include the psychosocial and environmental issues that may mitigate the risks to which children with prenatal opioid exposure are exposed early in life. The information resulting from this research topic will
inform clinical practice as well as encourage further research.
__________________________________________________________________________________
Keywords: Perinatal opioid exposure, prenatal opioid, neonatal abstinence, opioid withdrawal,
medication for opioid use disorder, developmental outcomes, pharmacological treatment
Important Note: All contributions to this Research Topic must be within the scope of the section and
journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right
to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
Syndrome (NAS). However, since we have a maternal/infant dyad, it is essential to include significant issues during pregnancy, birth, and postpartum that may influence the onset, progression, severity, and
duration of NAS.
The number of newborns with neonatal abstinence syndrome (NAS), who are born to women using opioids during pregnancy is steadily increasing. Substance Use Disorder (SUD) in pregnancy may occur as
a result of illicit drug use or misuse of prescribed medications for pain. NAS can result from the latter aswell as from medications for opioid use disorder (MOUD) for treatment of SUD in pregnancy. Current
studies describe methods to mitigate occurrence or decrease severity of NAS by using MOUD in divided doses and not daily. Although the term neonatal opioid withdrawal syndrome (NOWS) is referred to by
some investigators, NAS appropriately indicates the manifestations of withdrawal from opioids and often in combination with other substances such as tobacco, benzodiazepines, selective serotonin
inhibitors, barbiturates, methamphetamine, etc. Each of these substances has been reported to be associated with newborn withdrawal signs. In the clinical setting, in pregnancy, most women use more than one drug making NAS a more realistic term.
Manuscripts in Volume I provided a historical perspective on NAS, addressing the changing prevalence of the disorder over the years and the factors that may have contributed to its emergence as a public health problem. The comparison of clinimetric versus psychometric properties of scoring systems was elucidated as applied in clinical settings. Also included in Volume I were the genomics of NAS, the associated disturbances in suck-swallow-breath rhythm, and the electroencephalographic findings consistent with benign sleep myoclonus. Preclinical studies showed the effects of opioids on the developing brain at different stages of development; findings which may explain long-term behavioral effects, thus a basis for behavior teratology.
Recent research has shown that a number of issues during pregnancy can influence several aspects of NAS as well as the health of mother and baby. The importance of comprehensive services to include medical, psychosocial and appropriate protocols for medication treatment have been known and the lack of fragmentation of services is important. Protocols for withdrawal from opioids in pregnancy are available for selected patients and nuances with regard to specific issues during pregnancy should be considered. The mitigation of stress and methadone dosing guidelines are recently recommended. Covid-19 in pregnancy has been shown to cause certain morbidities and recommendations are on-going. Considerable emphasis should be provided on such issues as compassion, language and stigma when treatment is provided during pregnancy. Therefore, Volume II will include the current views on these topics as well as those described below. Important aspects of prenatal opioid exposure which continues to be debated are the diagnosis, assessment, treatment and monitoring of treatment for NAS.
Clinicians from different centers use different methods of assessment of NAS and there are also variations in the number of medications used for pharmacologic treatment. Although there are specific signs and manifestations unique to neonatal opioid withdrawal, there is little information regarding the physiological changes associated
with NAS. Another important area from a neonatal standpoint is the use of opioids for sedation and pain relief in surgical procedures or in Extracorporeal Membrane Oxygenation (ECMO) in newborns with
prenatal opioid exposure. The morbidity and mortality of infants with NAS through the first few months or a year post-discharge should be a major focus for short term outcomes. Addressing outcomes should
include the psychosocial and environmental issues that may mitigate the risks to which children with prenatal opioid exposure are exposed early in life. The information resulting from this research topic will
inform clinical practice as well as encourage further research.
__________________________________________________________________________________
Keywords: Perinatal opioid exposure, prenatal opioid, neonatal abstinence, opioid withdrawal,
medication for opioid use disorder, developmental outcomes, pharmacological treatment
Important Note: All contributions to this Research Topic must be within the scope of the section and
journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right
to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
Keywords: Prenatal opiate, neonatal abstinence, opiate withdrawal, developmental outcomes, pharmacological treatment
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
