Svnke Siefert wrote:
> How do you treat babies with neonatal drug withdrawal symptoms after mother consumed Methadon?
> Is there any influence of teratment with methadon on neurological developement?
> Thanks for your answer,
> S. Siefert from Hamburg, Germany
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
Acute narcotic withdrawal form methadone causes symptoms in about 75% of babies, though symptoms
are mild in mothers maintained on less than 20mg per day. Some irritability at birth may be
noted by the major symptoms of withdrawal occur at 2 to 3 weeks. Infant may also demonstrate a
sudden increase in appetite.
Infants of methadone using mothers have a lower birth weight, length and head circumference than
control infants. Head Circumference may not be normal by 2 years. Some studies show deficits in
motor skills by 18 months but others blame low socioeconomic status factors.
Other sequelae include abnormal interactive behavior and state control, poor auditory and visual
orientation responses, poor motor control, decreased quiet sleep, abstinence associated seizures,
a persistent Moro reflex and a five to ten fold increase in sudden infant death syndrome.
Forty percent can be treated without medication, including holding, rocking, decreasing
stimulation, swaddling, frequent small feedings of a hyper caloric formula (24 cals/30 ml).
the decision to start should be based on objective measurement of symptoms recorded on a
withdrawal sheet. The goal is to stop symptoms without sedating the infant, once goal has been
achieved the med can slowly be tapered.
Diluted tincture of opium (DTO) is the narcotic of choice because is controls all symptoms,
impairs suck the least and contains few additives, disadvantages include slow withdrawal,
continued exposure to narcotics and short shelf life, A 10% solution of tincture of opium USP
(Laudamum) is equal to morphine 1%. THis is diluted 25 fold with sterile water to a
concentration and potency equal to that of paregoric (0.4mg/ml morphine). This dilution is
stable for 2 weeks. The dose is 0.05ml/kg or two drops per kilo every 4-6 hours. The dose is
increased by 2 drops (or 0.05ml/kg) at the end of each 4 hour period until the desired response
Some babies will need medication more often than q 4h Once an adequate dose has been found it can
be tapered by 10% daily.
Length of treatment is 1-6 weeks
Side effects include sleepiness and constipation. Colace has been used to treat constipation
Watch for overdose and hold next dose if needed.
Hope this helps,
(Hey Jay Fisher, remember the good old days, done this once or twice????)
Marianne Sutton, MD, MPH
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: