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  • Letter to the Editor
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Strength in numbers: a step closer to standardising perinatal care for drug-misusing women and their infants

Journal of Perinatology volume 32, pages 157–158 (2012)Cite this article

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We read with great interest the recent paper by Isemann et al.1 In this retrospective review of 128 neonates the severity of neonatal abstinence syndrome (NAS) was mitigated by reducing maternal methadone dose during pregnancy and encouraging breastfeeding. We fully support these conclusions but believe there to be some shortcomings in the study including failure to document the incidence of NAS in the population studied. We caution against using length of stay as a proxy for NAS severity; these infants typically have complex social backgrounds and often require prolonged hospital stays simply to facilitate discharge planning.

Isemann et al.1 note that optimal management of NAS has been confounded by inconsistencies in the literature; it is unfortunate that they did not consider our review2 of 444 mother–infant pairs (by far the largest cohort studied to date), which provides a great deal of clarity. All our mothers were prescribed substitute methadone (median dose 50 mg per day, range 5–150 mg), and at least 80% used additional illicit drugs. 45.5% of infants received pharmacological treatment for NAS. The odds ratio of requiring treatment for NAS was independently related to prescribed maternal methadone dose (rather than associated polydrug misuse) and was halved by breastfeeding.

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References

  1. Isemann B, Meinzen-Derr J, Akinbi H . Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol 2011; 31: 25–29.

    Article  CAS  Google Scholar 

  2. Dryden C, Young D, Hepburn M, Mactier H . Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG 2009; 116: 665–671.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatrics, Wishaw General Hospital, Lanarkshire, Scotland, UK

    C Dryden

  2. Neonatal Unit, Princess Royal Maternity, Glasgow, Scotland, UK

    H Mactier

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  1. C Dryden
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  2. H Mactier
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Correspondence to C Dryden.

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Dryden, C., Mactier, H. Strength in numbers: a step closer to standardising perinatal care for drug-misusing women and their infants. J Perinatol 32, 157–158 (2012). https://doi.org/10.1038/jp.2011.124

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