Neonatal Visual Evoked Potentials in Infants Born to Mothers Prescribed Methadone.

Pediatrics. 2013 Feb 18;
McGlone L, Hamilton R, McCulloch DL, Boulton R, Bradnam MS, Weaver LT, Mactier H

OBJECTIVE:Drug misuse in pregnancy is associated with impaired infant visual development. Pilot data showed abnormal flash visual evoked potentials (VEPs) in neonates exposed to methadone in utero, but results were confounded by intrauterine growth restriction, gestation, and ongoing drug misuse. This large cohort study aimed to clarify the effects on neonatal flash VEPs of maternal drug misuse in pregnancy, including prescription of substitute methadone and subsequent development of neonatal abstinence syndrome.METHODS:This was a prospective cohort study. Flash VEPs were recorded within 3 days of birth from 100 healthy infants of drug-misusing mothers prescribed substitute methadone during pregnancy and 50 comparison infants matched for birth weight, gestation, and socioeconomic deprivation. VEP morphology was classified as mature, typical, or immature, and amplitudes and implicit times of the major waveform components measured. Drug exposure was determined by maternal history, maternal and infant urine, and meconium toxicology.RESULTS:VEPs from maternal drug-exposed infants were more likely to be of immature waveform (P < .001) and were smaller in overall amplitude (median 27 µV vs 39 µV, P < .001) compared with non-drug-exposed infants. Most infants were exposed to illicit drugs in addition to prescribed methadone; differences in VEP parameters were independently associated with maternal prescribed methadone and persisted after correcting for birth weight, cigarette smoking, and excess in utero alcohol exposure.CONCLUSIONS:In utero exposure to prescribed substitute methadone is associated with altered flash VEPs in the newborn period and these infants may warrant early clinical visual assessment. HubMed – Methadone

A review of methadone deaths between 2001 and 2005 in Victoria, Australia.

Forensic Sci Int. 2013 Feb 15;
Pilgrim JL, McDonough M, Drummer OH

This study examined methadone-associated deaths reported to the Coroner in Victoria, Australia, between 2001 and 2005. There were 206 deaths involving methadone, attributed predominantly to drug toxicity (137 cases), in addition to natural disease (24 cases), external injuries (44 cases) and one case where the cause was unascertained. The number of deaths each year did not rise significantly. There were 38 cases involving Physeptone(®) for chronic pain, 36 cases (14%) that were regarded as diversion deaths and 9 cases where the source of methadone was unknown. The remainder involved patients in opioid replacement therapy. Diversion deaths were signified by the unprescribed use of methadone by an individual not possessing a valid permit from the Victorian Department of Health. In these cases, the Coroner also described illicit use of the drug in the findings. Fifty-one individuals (25%; 15 female and 36 males) died within 14 days of commencing opioid replacement therapy with methadone administered via syrup. Many of these cases involved rapid dose increases of up to 25mg per day. The median starting dose was 35mg and the median (mean; range) blood methadone concentration was 0.5mg/L (0.6mg/L; 0.1-3.0mg/L). A number of cases were identified as having too high a starting dose, with 44% starting on 40mg or more. The OD4-methadone index indicated a substantial increase in relative methadone toxicity from around 28 per million DDDs in the early 1990s to over 60 in 2005. Ninety-eight percent of cases involved the use of other CNS depressants including: opioids, antidepressants, antipsychotics and ethanol, with benzodiazepines most common (88% confirmed positive). Improvements in the management of ORT, particularly in the induction period, has the potential to reduce mortality of patients receiving methadone.
HubMed – Methadone

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