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Is Your Infant Fussy? It Could Be Digestion
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Drug that Helps Adults Addicted to Opioid Drugs also Relieves Withdrawal Symptoms in Newborns

Newswise — Thousands of infants each year have exposure to opioids before they are born. Over half of these infants are born with withdrawal symptoms severe enough to require opioid replacement treatment in the nursery. Such treatment is associated with long hospital stays which interferes with maternal/infant bonding. Now, a team of researchers at Thomas Jefferson University has tested a semi-synthetic opioid they say has the potential to improve the treatment of these newborns, which could save hundreds of millions in healthcare costs annually if future tests continue to show benefit.





In the October 6th online issue of Addiction, the researchers say that using buprenorphine in a dozen addicted infants was both safe and successful and reduced days of treatment by 40 percent, compared to use of morphine in 12 other infants randomized to this treatment. The difference was 23 days of treatment versus 38 days.

“Given further study, such a beneficial drug could provide a new standard of treatment in a field where a well-defined therapeutic approach doesn’t exist,” says the study’s lead author, Walter Kraft, M.D., associate professor in the Department of Pharmacology and Experimental Therapeutics at Jefferson.
“Not only do we think buprenorphine is an excellent choice to treat neonatal opioid withdrawal, but it may prove to also be cost effective,” he says. “There are not good numbers to work with but we estimate up to 16,000 infants each year are at risk for the syndrome. If you assume the costs for this treatment are $2,000 a day over an average 30 days of hospitalization, annual charges for this treatment can be up to $1 billion.”

“If we were to reduce hospital stay by just 20 percent, that would save $150 million,” Dr. Kraft adds.

The investigative team, which includes experts in neonatology, addictions, clinical pharmacology and pediatric neurology are the first physicians to test buprenorphine in newborns. Buprenorphine is finding increased use in the treatment of adults with opioid dependence.

In infants, the agent was given sublingually – under the tongue – and to keep it there until it is absorbed, the physicians gave the babies pacifiers to suck. “This is the only report of a sublingual drug ever used in infants,” Kraft says.
Many of the mothers of the infants receive care at the Family Center, which cares for the majority of pregnant opioid-addicted women in the Philadelphia area, Dr. Kraft says. The program is directed by co-author Karol Kaltenbach, Ph.D., who is a internationally known expert in the treatment of pregnant women with addiction.

In 2008, the research team published results from their first cohort using buprenorphine in infants. In this study, they enrolled 24 infants, half randomized to buprenorphine and half to standard of care oral morphine. The investigators found that infants treated with buprenorphine had a 23-day length of treatment, compared to 38 days for those treated with morphine. Length of hospital stay in the buprenorphine group was 32 days versus 42 in infants treated with morphine.

“They say that to truly know if buprenorphine is a better treatment for these infants, it will be necessary to conduct a double-blind randomized study in which physicians do not know which treatment has been administered. We are not using buprenorphine in infants who need treatment until we conduct this final step,” Dr. Kraft says. “It is important to do the study in the most rigorous way possible, to prove the benefit of the therapy. We are currently in the planning stages of such a study.”

Other co-authors include neonatologists Kevin Dysart, M.D.; Eric Gibson, M.D.; Jay Greenspan, M.D., chairman of the Department of Pediatrics; and Michelle Ehrlich, M.D., a pediatric neurologist.

The project was supported by the Commonwealth of Pennsylvania Tobacco Fund and the National Institute on Drug Abuse.

Source: Thomas Jefferson University





Body Changes in Pregnancy

Preemies at Risk: How to Protect Them

(Family Features) - With state and federal budgets stretched thin, and cost-cutting a primary motivator for insurers, programs providing healthcare services for our tiniest citizens - especially premature infants - are becoming more limited and restrictive. But, being armed with the right information can help parents best navigate what health issues to watch out for and how to best protect their family in this rationing environment and, in particular, during this time of year.

Parents of Preemies Take Note

Preemies are at increased risk for a variety of health complications, including respiratory illnesses and chronic lung disease - even if they're born just a few weeks early. This is because they have underdeveloped lungs and immature immune systems in comparison with full-term babies.

As we approach the winter season, and seasonal viral activity escalates, it's important that parents of preemies understand their baby's health risks and ensure they have access to a variety of therapeutic options to help keep them healthy. For example, in addition to colds and the flu, there is another common virus that can be especially serious for the premature infant population: respiratory syncytial virus (RSV). RSV is a common, seasonal and easily spread virus that infects nearly all children by their second birthday. Most kids just get moderate to severe cold-like symptoms, however high-risk infants may get severe RSV disease. RSV disease is the most common cause of death due to a virus in children under five years of age and is responsible for an estimated 125,000 infant hospitalizations annually in the United States.

There are simple ways to help protect your baby from viruses such as RSV, including washing hands and bedding frequently, and limiting your baby's exposure to large groups and environmental tobacco smoke. And, of course, speak with your child's healthcare provider about any concerns and other prevention options.





sPreemies Now Face Added Challenge

While being diligent about monitoring the health needs of your little one greatly helps them live a healthy life, it's also important to note how current economic pressures and their impact on the healthcare system can affect your baby's access to services.

In particular, preemies and other vulnerable babies have been facing additional challenges because of healthcare system constraints, which are creating more restrictive reimbursement policies and forcing program cuts that limit access to care. Across the country, for example, 45 percent of local health departments experienced budget cuts in 2009, which led to nearly a quarter of these departments reducing funding for maternal and child health programs, such as Medicaid's Women, Infants and Children (WIC) program.

Private and public insurers alike are also creating barriers to care by using increasingly restrictive care guidelines to drive their eligibility decisions. For example, in 2009 the American Academy of Pediatrics issued more restrictive guidelines for RSV emphasizing cost issues over new or existing clinical data.

"One of the biggest challenges to ensure infants have access to the proper care they need is that insurers are adopting guidelines without considering all available clinical evidence, rather than analyzing high-risk infants on a case-by-case basis under the direction of the child's physician," said Dr. Mitch Goldstein, president of the National Perinatal Association.

What Can Parents Do?

If you're the parent of a preemie, talk with your child's pediatrician about proper prevention for all illnesses, such as respiratory illnesses like RSV disease. "If healthcare coverage is denied, you can likely appeal the decision. Your doctor should be able to advise you on the appeals process and share additional resources that can help you," said Dr. Goldstein. "When there is advocacy from both the parent and the physician, there is more likelihood of success."

All babies deserve equal access to preventive care, and physicians, nurses, payers and parents must work together to protect them. Go to www.preemievoices.com or www.nationalperinatal.org for more information on preemies and infant health. To learn more about the signs, symptoms and risk factors of RSV disease, as well as additional prevention tips, visit www.rsvprotection.com.

SOURCE:
Medimmune