Author/Editor		Bregant, Lev
Title		Ali je dojenje varno tudi pri jemanju visokih odmerkov metadona (prikaz primera)
Translated title		Is breast-feeding save even with high-dose methadone treatment? (a case report)
Type		članek
Source		Odvisnosti
Vol. and No.		Letnik 1, št. 1-2
Publication year		2000
Volume		str. 36-8
Language		slo
Abstract		Neonatal narcotic abstinence syndrome (NNAS) is a frequent complication in the newborns of mothers who have been receiving methadone during pregnancy. A positive correlation has been found between the severity of withdrawal signs and the dose of the drug used. The signs of NNAS are the consequence of an exaggerated excitement of the central nervous system. The aim of treatment is to calm the newborn wiih the lowest sedation possible. To achieve this we recommend morphine and phenobarbital as the first choice or a combination of both following a scheme formulated in accord with the severity of the withdrawal signs. We report on a case of a mature newborn baby girl with NNAS whose mother was on a high-dose methadone maintenance program during pregnancy and after delivery (115 mg daily). The new-born developed mild signs of the withdrawal syndrome on the first day after birth. After a transient improvement, a heavy abstinence crisis developed on the third day of life, despite breast-feeding and medical treatment with barbiturates and valium. Methadone was not detected in the newborn's serum, but traces were found in her urine. The amount of methadone received through breast-feeding was too small to prevent the occurrence of the withdrawal syndrome. In addition, it did not have a narcotic effect on the newborn. We are therefore of the opinion that despite high doses of methadone. the mother may breast-feed her baby. Since the amount of methadone received through breast milk is too small to prevent withdrawal signs, the use of morphine preparations according to a scheme is recommended.
Summary		Neonatalni narkotični abstinenčni sindrom (NNAS) je pogosta komplikacija pri novorojenčkih mater, ki so v nosečnosti prejemale metadon. Ugotavljajo pozitivno povezavo med stopnjo odtegnitvenih znakov in odmerkom zdravila. Znaki NNAS so posledica prevelike vzdražnosti centralnega živčevja. Cilj zdravljenja je pomiritev novorojenčka ob čim manjši sedaciji; za dosego tega priporočajo predvsern morfin in fenobarbiton ali kombinacijo obeh po shemi glede na izraženost odtegnitvenih znakov. Opisana je donošena novorojenka z NNAS, katere mati je v nosečnosti in po porodu prejemala visoko dozo metadona (115 mg dnevno). Deklica je že dan po porodu kazala blage znake odtegnitvenega sindroma. Po prehodnem izboljšanju se je tretji dan razvila težka abstinenčna kriza kljub dojenju in zdravljenju z barbiturati ter anksiolitiki. V serumu otroka metadona nismo našli, v urinu paje bil ta le v sledeh. Prek mleka prejeta količina metadona je bila premajhna, da bi preprečila pojav abstinenčnih znakov. Prav tako ni imela narkotičnega vpliva na novorojenčka, zato menimo, da mati lahko doji kljub visokim odmerkom metadona. Ker je količina prek mleka zaužitega metadona premajhna za preprečitev abstinenčnih znakov, svetujemo uporabo morfinskih preparatov po shemi.
Descriptors		NEONATAL ABSTINENCE SYNDROME PHENOBARBITAL NARCOTIC DEPENDENCE METHADONE BREAST FEEDING INFANT, NEWBORN ADULT PREGNANCY