Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Author(s): Stephanie Merhar, Songthip Ounpraseuth, Lori Devlin, et al.

What was done?

We reviewed medical records from 30 U.S. hospitals. There were 180 babies with NOWS treated with morphine (M) and a secondary drug [phenobarbital (P) or clonidine (C)]. We compared the two groups (M + P and M + C) and calculated the number of days spent in the hospital and the number of days they received morphine.

What was found?

Babies in the M + P group had fewer days of morphine treatment compared to babies in the M + C group. They also spent fewer days in the hospital than the M + C group. However, babies in the M + P group were more likely to continue taking phenobarbital at home.

What do the results mean?

In this study, babies treated with M + P had shorter hospital stays, and in some cases, fewer days of morphine treatment. But, some studies show that long-term use of phenobarbital could cause problems with the development of the nervous system. More research is needed on the benefits and risks of using this drug to treat NOWS symptoms.

Why was this study conducted?

Babies exposed to opioids (e.g., morphine, methadone, etc.) in the womb may have drug withdrawal symptoms called neonatal opioid withdrawal syndrome (NOWS) after birth. Some are given medicine for their symptoms. If the medicine doesn’t work, doctors may add other (secondary) medicine to the treatment. This study looked at two secondary drugs used most often to see if one was better than the other in NOWS treatment.

Appreciation:

We deeply appreciate the doctors, nurses, and hospitals that participated in the study and helped identify and extract information from the required medical records. Their enthusiastic collaboration made this study possible. The authors thank the Environmental Influences on Child Health Outcomes Program, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Center for Advancing Translational Sciences, and the National Institutes of Health for supporting this research.

Access the full journal article, titled "Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome," published in Pediatrics.

Published March, 2021

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome

Resources

Centers for Disease Control and Prevention (CDC)

About Opioid Use During Pregnancy

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ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

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ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health. Individual authors were additionally supported by the National Institutes of Environmental Health Sciences, Diabetes and Digestive and Kidney Diseases, and Alcohol Abuse and Alcoholism.

What were the study results?

The strongest evidence points to a connection between human-made chemicals called polychlorinated biphenyls and a longer time to get pregnant. These chemicals used to be used in electrical and hydraulic equipment. Even though production of these chemicals stopped in the late 1970s, we are still exposed to them through soil, water, and building materials. Another group of chemicals called organochlorine pesticides do not seem to affect the time it takes to get pregnant. We still need more research on brominated flame retardants, found in furniture, clothing, and other household products, and per- and polyfluoroalkyl substances, found in non-stick cookware and stain-resistant fabrics. Many of the newer chemicals in these categories have not yet been studied.

What was the study's impact?

This review shows that some long-lasting chemicals may increase the time it takes for couples to get pregnant. This can be stressful and lead couples to seek expensive fertility treatment. Although many of the chemicals covered in our review are no longer made or used in the US, they can last for years—even decades—in the environment and in our bodies. Therefore, they can still affect our health. We need more research on newer chemicals that have been invented to replace dangerous ones. We also need to figure out exactly how these chemicals interfere with healthy reproduction. For example, there may be times in life, such as puberty, when being exposed to them may be especially damaging. The ECHO Program is an important resource for answering these questions.

Why was this study needed?

Some human-made chemicals can cause problems with the reproductive system. Many studies have looked at whether these chemicals affect how long it takes to get pregnant. How long it takes to become pregnant is a sign of a couple’s reproductive health and can be a sign that they need to seek fertility treatment. Our review compares the results of past studies to see if there are consistent patterns for particular types of chemicals. It also identifies chemicals that need further research.

Who was involved?

This review includes all papers published in English on this topic from January 1, 2007 to August 6, 2019. Our search looked at 28 articles. These articles used data from 19 different studies. The studies took place in North America, Europe, and East Asia.

What happened during the study?

We searched five science libraries and found more than 4500 articles that could possibly fit our topic and narrowed them down to the 28 articles discussed in our paper. We read each article carefully, gave it a score based on its quality, and pulled out the most important information. This included whether the chemicals the paper looked at affected how long it took to get pregnant, and if so, by how much. We then put that information into tables. Finally, we looked at whether or not results were consistent, especially among high-quality studies. We then drew our conclusions.

What happens next?

This is the second review that this team of authors has written on chemicals and time to pregnancy. Our next paper will look at whether different types of air pollution affect how long it takes to get pregnant.

Where can I learn more?

Access the full journal article titled "Persistent organic pollutants and couple fecundability: a systematic review" published in Human Reproduction Update.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: February 19, 2021

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ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

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Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

Author(s): Brett Doherty and Megan Romano

Who sponsored this study?

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, and grant funding.*

What were the study results?

Researchers found 199 unique chemicals in the wristbands worn by women in the study. There were 16 chemicals, including chemicals in personal care products and consumer goods, which were found most often. Most women had comparatively low amounts of exposures to these chemicals but others had more unique combinations of chemical exposures. Education and behaviors, such as nail polish use, helped predict the level of chemical exposures.

What was the study's impact?

This work helps identify opportunities and challenges for using tools like silicone wristbands to understand chemical exposures during pregnancy. The research team also identified common exposures and exposure patterns within the study population, which may be studied in future research.

Why was this study needed?

Pregnant women are exposed to chemicals that may be bad for their health or their babies’ health. At the same time, the types of chemicals and their co-occurrence are not well understood. The researchers used silicone wristbands that capture chemicals in the environment to learn more about these exposures in a group of pregnant women in northern New England.

Who was involved?

This study included 255 women enrolled in the New Hampshire Birth Cohort Study (NHBCS) between 2017 and 2019. The NHBCS began in 2009 and includes more than 2,000 mother and child pairs.

What happened during the study?

During early pregnancy, the women wore the wristbands and went about their normal activities while chemicals in their environment became trapped in their wristbands. The women then returned the wristbands after one week and researchers measured the captured chemicals. This provided information about the chemicals in the women’s environments.

What happens next?

The team will connect the chemical exposure information collected from the silicone wristbands to maternal and infant health outcomes. This connection may show how chemicals influence human health and provide clues to prevent health problems. The team will also compare these wristband measurements to traditional measurements of chemical exposures. This will help scientists better understand the strengths and weaknesses of this new technology.

Where can I learn more?

Access the full journal article , titled “Assessment of Multipollutant Exposures During Pregnancy Using Silicone Wristbands” published in Frontiers in Public Health.

Additional details

This work included collaboration with Dr. John Pearce, who, like Dr. Romano, is an OIF Cycle 1 Awardee. Dr. Pearce provided expertise related to the statistical methods used in this research, which he developed through his project entitled “Developing exposure characterization tools to address complex exposures within ECHO” (EC0155).

*Award Numbers include U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3 OD023275, and the National Institute of Environmental Health Sciences under Award Number P42ES007373. Brett T. Doherty was supported by National Cancer Institute grant R25CA134286.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: September 29, 2020

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Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

ECHO Review Finds No Strong Link Between Non-Persistent Chemical Exposures Found in Consumer Products and the Time It Takes Couples to Get Pregnant

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ECHO Review Finds No Strong Link Between Non-Persistent Chemical Exposures Found in Consumer Products and the Time It Takes Couples to Get Pregnant

Author(s): Alison E. Hipwell, Linda G. Kahn, Pam Factor-Litvak, et al

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health. This work was also supported by NIH grants P30 ES009089, R01ES013543, R01ES014393, R01ES08977, and T32ES023772.

What were the study results?

There were some signs that when either men, women, or both were exposed to certain chemicals, it took a longer for the couple to get pregnant. But more research needs to be done to truly understand those effects. There were also signs that certain chemicals did not have any effects.

*Results reported here are for a single review of specific studies during a 10-year period. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The papers we reviewed did not show a strong link between non-persistent chemicals and how long it takes to get pregnant. But, because there are not many studies like this, we concluded that more research is needed. While we wait for more research, it does not hurt to try to avoid certain chemicals in case they could affect the chances of becoming pregnant. We suggest common-sense lifestyle changes for men and women who would like to have a child. These include trying to avoid contact with certain non-persistent chemicals. Some ways to do this would be to use fewer plastic food containers and look at ingredient lists on personal care and cleaning products in order to avoid phthalates, parabens, TCS, benzophenones, and glycol ethers.

Why was this study needed?

Many products that people use contain non-persistent chemicals that can disrupt hormones. Non-persistent chemicals are chemicals that are broken down fairly quickly in the environment and in the human body. Therefore, non-persistent chemicals are often used in everyday household products. Some studies show these chemicals may affect people’s chance to get pregnant or may cause problems in pregnancy. These chemicals may also affect how long it takes for a couple to become pregnant, but not many studies have tried to answer this question. The goals of this study were to:

Review and summarize what is known about possible links between non-persistent chemicals and the time it takes to get pregnant.
To identify what information is missing in existing studies about this topic.
To present our results in a way that might change health policies and future research about chemicals in products that people use.

Who was involved?

This review looked at existing studies of healthy men and women who were in the age range to get pregnant. The studies were done in several different countries and ranged in size from 137 to 10,512 participants.

What happened during the study?

We used several sets of data to do a large search of research papers published from 2007 to 2017. We searched for articles about both common non-persistent chemicals and time to get pregnant. Our search found 3,456 articles. Two authors reviewed each of the articles we found to make sure they included information we needed. We found that 15 papers from 12 different studies, and then we pulled information from those for our review.

What happens next?

We are doing another review that will study whether there is a connection between chemicals that stay in the body for a long time and the time it takes to become pregnant.

Where can I learn more?

Access the full journal article titled, “Exposure to non-persistent chemicals in consumer products and fecundability: a systematic review” in Human Reproduction Update.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: January 1, 2019

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ECHO Review Finds No Strong Link Between Non-Persistent Chemical Exposures Found in Consumer Products and the Time It Takes Couples to Get Pregnant

ECHO Study Suggests Exposure to Opioids During Pregnancy May Have Subtle Effects on Child Health Outcomes

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ECHO Study Suggests Exposure to Opioids During Pregnancy May Have Subtle Effects on Child Health Outcomes

Author(s): Elisabeth Conradt, Sheila Crowell and Barry Lester

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

We were not able to learn what the short and long-term results of prenatal opioid exposure were because of the limitations with the existing information. Our best working hypothesis is that the effects of prenatal opioid exposure at birth and in infancy are small and subtle, but that the effects may grow as children age and have more demands on their attention at home and at school.

What was the study's impact?

We are still trying hard to learn about the short and long-term developmental effects of prenatal opioid exposure. We think that the effects of prenatal opioid exposure at birth and in infancy are subtle, and that they could be also be caused by the effects of other things such as poverty and early life stress. The effects in childhood may be stronger, but they could also be due to long-term stress exposure. More high-quality research is needed to answer the question, “how does prenatal opioid exposure affect the child?”

Why was this study needed?

We have very little information about how a mother’s use of opioids during pregnancy (prenatal opioid exposure) can affect child development. The information we have thus far is limited by not having many people to study and not being able to study other factors that may have an effect on child development, such as poverty. For this study, we reviewed what information we know so far and also made suggestions for how to improve knowledge of prenatal opioid exposure.

Who was involved?

This publication was a review of information that had already been published. After review, we came together as a group and decided what should be done next to answer the question, “how does prenatal opioid exposure affect the child?”

What happened during the study?

We reviewed over 50 studies to try to come up with some answers about how being exposed to opioids during pregnancy affects a child over short and long periods of time. We then discussed the limitations of the study and developed a list of what can be done in the future to fix these limitations. We concluded by describing how ECHO can help provide more information about this research topic.

What happens next?

We will use the ECHO data that are already collected to test how prenatal opioid exposure affects knowledge/understanding, behavior, and attention span in middle childhood. We will consider other possible factors such as poverty. We will also look at whether newborns who have Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) have worse effects compared to newborns exposed to opioids who do not have NAS/NOWS.

Where can I learn more?

Access the full journal article, titled "Early life stress and environmental influences on the neurodevelopment of children with prenatal opioid exposure," published in Neurobiology of Stress.

Visit NIDA’s website to learn more about opioid use and prenatal opioid exposure: https://www.drugabuse.gov/drugs-abuse/opioids

Access the Harvard Center on the Developing Child website to understand how to reduce the negative effects of early life stress exposure: https://developingchild.harvard.edu/

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: August 15, 2018

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ECHO Study Suggests Exposure to Opioids During Pregnancy May Have Subtle Effects on Child Health Outcomes