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. 2003 Jul;88(4):F308–F311. doi: 10.1136/fn.88.4.F308

Naloxone for narcotic exposed newborn infants: systematic review

W McGuire, P Fowlie
PMCID: PMC1721582  PMID: 12819163

Abstract

Background: Naloxone, a specific opiate antagonist, is available for the treatment of newborn infants with respiratory depression that may be due to transplacentally acquired opiates.

Aims: To determine if this treatment has any clinically important benefits, and whether there are any harmful effects.

Methods: Randomised controlled trials that compared naloxone with placebo or no drug for newborn infants with transplacental exposure to narcotics were systematically reviewed. The Cochrane Controlled Trials Register (CCTR; 2002, Issue 3), Medline (1966 to June 2002), and Embase (1988 to June 2002) were searched. Data were extracted, analysed, and synthesised using the standard methods of the Cochrane Neonatal Collaborative Review Group.

Results: Nine trials were found that fulfilled the specified inclusion criteria. Although there was evidence that naloxone increased alveolar ventilation, no data were found on the specified primary outcomes of this review: the need for assisted ventilation or admission to a neonatal unit.

Conclusions: There is a need for a randomised controlled trial to determine if naloxone confers any clinically important benefits on newborn infants with respiratory depression that may be due to transplacentally acquired narcotic.

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Figure 1 .

Figure 1

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Effect of naloxone on the alveolar ventilation rate (ml/kg/min). CI, Confidence interval.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bonta B. W., Gagliardi J. V., Williams V., Warshaw J. B. Naloxone reversal of mild neurobehavioral depression in normal newborn infants after routine obstetric analgesia. J Pediatr. 1979 Jan;94(1):102–105. doi: 10.1016/s0022-3476(79)80369-8. [DOI] [PubMed] [Google Scholar]
  2. Brice J. E., Moreland T. A., Walker C. H. Effects of pethidine and its antagonists on the newborn. Arch Dis Child. 1979 May;54(5):356–361. doi: 10.1136/adc.54.5.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dick W., Knoche E., Traub E. Clinical investigations of the influence of various naloxone doses on the newborn. J Perinat Med. 1978;6(2):95–110. doi: 10.1515/jpme.1978.6.2.95. [DOI] [PubMed] [Google Scholar]
  4. Evans J. M., Hogg M. I., Rosen M. Reversal of narcotic depression in the neonate by nalozone. Br Med J. 1976 Nov 6;2(6044):1098–1100. doi: 10.1136/bmj.2.6044.1098. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gerhardt T., Bancalari E., Cohen H., Rocha L. F. Use of nalotone to to reverse narcotic respiratory depression in the newborn infant. J Pediatr. 1977 Jun;90(6):1009–1012. doi: 10.1016/s0022-3476(77)80583-0. [DOI] [PubMed] [Google Scholar]
  6. Herschel M., Khoshnood B., Lass N. A. Role of naloxone in newborn resuscitation. Pediatrics. 2000 Oct;106(4):831–834. doi: 10.1542/peds.106.4.831. [DOI] [PubMed] [Google Scholar]
  7. Niermeyer S., Van Reempts P., Kattwinkel J., Wiswell T., Burchfield D., Saugstad O. D., Milner A., Knaebel S., Perlman J., Azzopardi D. Resuscitation of newborns. Ann Emerg Med. 2001 Apr;37(4 Suppl):S110–S125. doi: 10.1067/mem.2001.114126. [DOI] [PubMed] [Google Scholar]
  8. Smotherman W. P., Robinson S. R. Prenatal experience with milk: fetal behavior and endogenous opioid systems. Neurosci Biobehav Rev. 1992 Fall;16(3):351–364. doi: 10.1016/s0149-7634(05)80205-2. [DOI] [PubMed] [Google Scholar]
  9. Szeto H. H., Soong Y., Wu D. L., Cheng P. Y. Opioid modulation of fetal glucose homeostasis: role of receptor subtypes. J Pharmacol Exp Ther. 1995 Oct;275(1):334–339. [PubMed] [Google Scholar]
  10. Welles B., Belfrage P., de Château P. Effects of naloxone on newborn infant behavior after maternal analgesia with pethidine during labor. Acta Obstet Gynecol Scand. 1984;63(7):617–619. doi: 10.3109/00016348409155548. [DOI] [PubMed] [Google Scholar]
  11. Wiener P. C., Hogg M. I., Rosen M. Effects of naloxone on pethidine-induced neonatal depression. Part I--Intravenous naloxone. Br Med J. 1977 Jul 23;2(6081):228–229. doi: 10.1136/bmj.2.6081.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Wiener P. C., Hogg M. I., Rosen M. Effects of naloxone on pethidine-induced neonatal depression. Part II--Intramuscular naloxone. Br Med J. 1977 Jul 23;2(6081):229–231. doi: 10.1136/bmj.2.6081.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Wiener P. C., Hogg M. I., Rosen M. Neonatal respiration, feeding and neurobehavioural state. Effects of intrapartum bupivacaine, pethidine and pethidine reversed by naloxone. Anaesthesia. 1979 Nov-Dec;34(10):996–1004. doi: 10.1111/j.1365-2044.1979.tb06247.x. [DOI] [PubMed] [Google Scholar]
  14. de-Castro R. M., Cabral-Filho J. E., Costa J. A., Costa F. B., Gallindo M. A., Hecksher C. A. Neonatal treatment with naloxone causes permanent hyperalgesia in rats. Braz J Med Biol Res. 1993 Jul;26(7):747–751. [PubMed] [Google Scholar]

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