TY - JOUR
KW - Analgesics, Opioid/therapeutic use
KW - Child
KW - Female
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Neonatal Abstinence Syndrome/diagnosis/epidemiology
KW - Opiate Alkaloids/therapeutic use
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/diagnosis/drug therapy/epidemiology
KW - Perinatal Care
KW - Pregnancy
KW - Pregnancy Complications/diagnosis/drug therapy/epidemiology
KW - Neonatal abstinence syndrome
KW - neonatal opiate withdrawal syndrome
KW - Opiate
KW - substance use
AU - M. P. Howell
AU - A. M. Smith
AU - E. B. Lindsay
AU - S. S. Drury
A1 - 
AB - Neonatal opiate withdrawal syndrome (NOWS), previously known as neonatal abstinence syndrome (NAS), is a growing public health concern as opiate misuse and opioid-related overdoses, from both prescription and illicit sources, continue to rise in the USA. As more than 90% of females abusing opioids are of child-bearing age, the failure to adequately address the opioid epidemic continues to negatively impact the next generations. Accurate and timely identification of infants at risk for withdrawal from in-utero exposure is critical to ensure high-quality perinatal and neonatal care. Beginning with an evaluation of current best practices and performing a literature review, we identify the challenges to current screening processes and how these limitations limit the ability to provide appropriate care to infants at the risk of withdrawal. We first describe the limitations of the available assays for the detection of opioid and opioid metabolites across different biological sources from both the mother and the infant. We then present a discussion surrounding factors that contribute to maternal willingness to disclose use. Particularly, in light of the limitations of biological screening, any barrier to maternal disclosure further complicates effective care delivery. Barriers to disclosure include legal ramifications and state policies, provider and societal behaviors and biases, and maternal factors. Moving forward, universal prenatal screening surveys coupled with enhanced outreach and education to providers centering on the limitations of both patient report and biological sampling, as well as comprehensive and supportive services for women of reproductive age with substance use disorders, are needed to both enhance detection for NOWS and improve long-term maternal-child health.
AD - Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA.; Tulane University School of Medicine, New Orleans, LA, USA.; Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA.; Department of Child and Adolescent Psychiatry, Tulane University School of Medicine, New Orleans, LA, USA.
BT - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
C5 - Education & Workforce; Healthcare Disparities; Measures; Opioids & Substance Use
CP - 7
CY - England
DO - 10.1080/14767058.2019.1627316
IS - 7
JF - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
LA - eng
M1 - Journal Article
N2 - Neonatal opiate withdrawal syndrome (NOWS), previously known as neonatal abstinence syndrome (NAS), is a growing public health concern as opiate misuse and opioid-related overdoses, from both prescription and illicit sources, continue to rise in the USA. As more than 90% of females abusing opioids are of child-bearing age, the failure to adequately address the opioid epidemic continues to negatively impact the next generations. Accurate and timely identification of infants at risk for withdrawal from in-utero exposure is critical to ensure high-quality perinatal and neonatal care. Beginning with an evaluation of current best practices and performing a literature review, we identify the challenges to current screening processes and how these limitations limit the ability to provide appropriate care to infants at the risk of withdrawal. We first describe the limitations of the available assays for the detection of opioid and opioid metabolites across different biological sources from both the mother and the infant. We then present a discussion surrounding factors that contribute to maternal willingness to disclose use. Particularly, in light of the limitations of biological screening, any barrier to maternal disclosure further complicates effective care delivery. Barriers to disclosure include legal ramifications and state policies, provider and societal behaviors and biases, and maternal factors. Moving forward, universal prenatal screening surveys coupled with enhanced outreach and education to providers centering on the limitations of both patient report and biological sampling, as well as comprehensive and supportive services for women of reproductive age with substance use disorders, are needed to both enhance detection for NOWS and improve long-term maternal-child health.
PP - England
PY - 2021
SN - 1476-4954; 1476-4954
SP - 1161
EP - 1166
EP - 
T1 - Understanding barriers to timely identification of infants at risk of neonatal opiate withdrawal syndrome
T2 - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
TI - Understanding barriers to timely identification of infants at risk of neonatal opiate withdrawal syndrome
U1 - Education & Workforce; Healthcare Disparities; Measures; Opioids & Substance Use
U2 - 31195865
U3 - 10.1080/14767058.2019.1627316
VL - 34
VO - 1476-4954; 1476-4954
Y1 - 2021
Y2 - Apr
ER -