Letters Drugs for opioid dependence

Neonatal abstinence syndrome can be a problem

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e4200 (Published 19 June 2012) Cite this as: BMJ 2012;344:e4200
  1. Helen Mactier, consultant neonatologist1,
  2. Laura McGlone, neonatal paediatric grid trainee1,
  3. Ruth Hamilton, consultant clinical scientist2,
  4. Jane R MacKinnon, consultant paediatric ophthalmologist3
  1. 1Princess Royal Maternity, Glasgow G31 2ER, UK
  2. 2Department of Clinical Physics and Bioengineering, University of Glasgow and the Royal Hospital for Sick Children, Glasgow, UK
  3. 3Royal Hospital for Sick Children, Glasgow, UK
  1. helen.mactier{at}ggc.scot.nhs.uk

Farrell and colleagues note that in pregnancy “methadone (substitution treatment) is safe and effective in terms of consistently better obstetric and perinatal outcomes.”1 They indicate that the only complication for the baby is a risk of neonatal abstinence syndrome and suggest that this “can be readily managed with withdrawal management and supportive care.”

We agree that the evidence strongly indicates benefit to mother and baby in terms of better compliance with antenatal care and reduced incidence of preterm birth, but question whether neonatal abstinence syndrome is “readily managed.” Those in neonatal practice know that this syndrome is distressing and has many adverse implications, including prolonged neonatal stay (often with prolonged mother-baby separation) and administration of oral morphine or phenobarbital to the infant (often for many weeks). Such events undoubtedly place further stress upon already fragile parenting situations. Furthermore, there is increasing evidence of longer term adverse implications for the infant, including poor postnatal growth, delayed early visual development, and impaired cognitive function.2 3 4 Recognised visual sequelae of maternal drug misuse in pregnancy—including strabismus, impaired visual processing, and nystagmus—may confer lifelong impairment of vision.

Everyone involved in managing pregnant women with opioid dependence should be aware of the risks to the child and ensure that such children are kept under close community review. This may be difficult, and, in the absence of concerns expressed by parents or carers, it should not be assumed that all is well. Failure to achieve normal developmental milestones should prompt urgent referral to appropriate paediatric services.


Cite this as: BMJ 2012;344:e4200


  • Competing interests: None declared.