NeoReviews最新文献

Perinatal substance use is rising in the United States, contributing to increasing numbers of infants with prenatal substance exposure and maternal mortality due to substance use disorder (SUD). Nearly every state in the United States has a Perinatal Quality Collaborative (PQC), and many focus on standardizing care, promoting evidence-based practices, and improving outcomes for pregnant people and infants affected by substance use. In this review, we summarize the strategies adopted by some PQCs including pregnancy and postpartum care bundles, universal SUD screening, mental health interventions, overdose prevention efforts, and management of neonatal opioid withdrawal syndrome. We describe positive outcomes of these initiatives, including decreased pharmacologic therapy and improved discharge practices. We also highlight some areas that require attention such as measuring short-term and long-term outcomes of these practices.

Cannabis is the most commonly used federally illicit substance during pregnancy in the United States, with an estimated prevalence of 3% to 30%. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics discourage cannabis use during pregnancy and breastfeeding due to safety concerns for the fetus and infant. Despite these recommendations, nearly half of active cannabis users continue use in pregnancy. In this review, we summarize cannabis pharmacology and metabolism with a focus on delta-9-tetrahydrocannabinol, the psychoactive component of the cannabis plant, highlighting its significance in quantifying exposure and the impact on outcomes studies. We also provide a concise review of current evidence on the effects of perinatal cannabis use and pregnancy, infant, and childhood outcomes, acknowledging the limitations of this evidence. Additionally, we provide targeted counseling recommendations for harm reduction strategies and lactation considerations for birthing parents who use cannabis.

Plans of Safe Care, first mentioned in US federal legislation in 2003, are intended to address the health and safety of infants and families impacted by prenatal substance exposure. However, despite having been in existence for more than 2 decades, variability in defining abuse and neglect as it pertains to in utero substance exposure and inconsistencies in interpretation and implementation of legislation at the state level have made it difficult to assess the impact of Plans of Safe Care. When used as a tool for care coordination, health care providers, in collaboration with child protective services and community-based organizations, can use Plans of Safe Care to improve outcomes of infants and families affected by substance use disorder. This review summarizes the background and core components of Plans of Safe Care.

Toxicology testing is a commonly used tool applied to the identification and management of infants with prenatal substance exposure. Although such testing has the potential to aid in the clinical management of newborns, clinicians who order such testing are frequently unaware of the limitations and harms of testing and the impact of the test results on the pregnant person-newborn dyad. In this review, we summarize the types and limitations of neonatal toxicology tests and identify areas for improvement, including policy change and advocacy, to drive equitable care for newborns and families with perinatal substance exposure. Clinicians ordering toxicology testing for neonates must understand their facility's testing capabilities, the screening vs confirmatory nature of that available testing, how to proceed with confirmatory testing of a screening test, and how to accurately interpret the result of that test.

The introduction of the eat, sleep, console (ESC) approach in 2017 represented a significant change in the approach to clinical care of neonates with neonatal opioid withdrawal syndrome (NOWS). The ESC approach uses 3 components of infant functioning to drive decision-making instead of scoring systems based on individual withdrawal symptoms. These nonpharmacologic interventions are first-line strategies that are maximized before the potential introduction of opioid therapy, and caregiver presence at the neonatal bedside is emphasized to ensure success of this approach. Since the introduction of the ESC method, several studies have examined its effectiveness and outcomes compared with prior traditional methods of NOWS management. By understanding the components of ESC management and the outcomes of neonates treated by this approach, clinicians can promote evidence-based best practices to optimize the care of neonates experiencing NOWS.

Diarrhea in neonates is usually secondary to an infectious process or a food protein allergy. Once the infection is treated or the allergen is removed, the diarrhea resolves without lifelong sequelae. On the contrary, infants with anatomical disorders such as intestinal atresia, gastroschisis, malrotation with volvulus, or necrotizing enterocolitis can present with protracted diarrhea secondary to poor gut motility and short bowel syndrome. A small group of infants who present with severe diarrhea shortly after birth can have a congenital enteropathy resulting from a monogenic disorder. This group poses clinical challenges that require intensive resuscitation and meticulous diagnostic evaluation aimed at optimizing interventions and outcomes. In this review, we will provide a diagnostic and management approach for infants with congenital enteropathies.