Abbreviations
- NAS
neonatal abstinence syndrome
- RCT
randomized controlled trial
Context and Policy Issues
Neonatal abstinence syndrome (NAS) is defined as drug withdrawal symptoms experienced by a neonate upon birth due to maternal drug use during pregnancy.1 Symptoms can include irritability, poor sucking, hypertonia, low birth weight and seizures.1 NAS occurs most commonly with maternal opioid use, but can occur with other substances such as cocaine, cannabis, and amphetamines (including crystal methamphetamine).1 Maternal drug abuse, both licit and illicit, has been growing in Canada.2 Mothers who use methamphetamines in pregnancy tend to be younger, have lower levels of education, lower socioeconomic status, are more likely to drink and smoke during pregnancy, and have less prenatal care prior to child birth.2 Pregnant persons who abuse drugs and their children are often a vulnerable group and require extra care and treatment.2 Care for NAS due to opioids usually includes non-pharmacological treatment and pharmacological treatments, but standardization of care is difficult as symptoms of withdrawal may differ between neonates.3
The purpose of this report is to examine recent literature regarding diagnosis and treatment of NAS due to crystal methamphetamine.
Research Questions
What is the clinical effectiveness of interventions for the treatment of neonatal abstinence syndrome due to crystal methamphetamine?
What is the comparative clinical effectiveness of tools for the diagnosis and monitoring of neonatal abstinence syndrome due to crystal methamphetamine?
What are the evidence-based guidelines regarding the treatment of neonatal abstinence syndrome due to crystal methamphetamine?
Key Findings
No relevant literature was identified regarding clinical effectiveness of interventions for the diagnosis and treatment of neonatal abstinence syndrome due to crystal methamphetamine. Additionally, no evidence based guidelines were identified regarding treatment or diagnosis of neonatal abstinence syndrome due to crystal methamphetamine.
Methods
Literature Search Methods
A limited literature search was conducted by an information specialist on key resources including Medline and PsycINFO via OVID, the Cochrane Library, University of York Centre for Reviews and Dissemination (CRD) databases, Canadian and major international health technology agencies, as well as a focused Internet search. The search strategy was comprised of both controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. The main search concepts were methamphetamine and neonates or neonatal abstinence. No filters were applied to limit the retrieval by study type. Where possible, retrieval was limited to the human population. The search was also limited to English language documents published between January 1, 2014 and May 14, 2019.
Selection Criteria and Methods
One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in .
Exclusion Criteria
Articles were excluded if they did not meet the selection criteria outlined in , they were duplicate publications, or were published prior to 2014. Guidelines with unclear methodology were also excluded.
Summary of Evidence
Quantity of Research Available
A total of 374 citations were identified in the literature search. Following screening of titles and abstracts, 362 citations were excluded and 12 potentially relevant reports from the electronic search were retrieved for full-text review. No potentially relevant publications were retrieved from the grey literature search for full-text review. Of these potentially relevant articles, all 12 publications were excluded for various reasons, and no publications met the inclusion criteria and were included in this report. Appendix 1 presents the PRISMA4 flowchart of the study selection. Additional references of potential interest are provided in Appendix 2
Summary of Findings
No relevant literature or evidence-based guidelines were identified regarding the clinical effectiveness of interventions or recommendations for diagnosis or treatment of neonatal abstinence syndrome due to crystal methamphetamine; therefore, no summary can be provided.
Limitations
No relevant literature was identified regarding clinical effectiveness of interventions for diagnosis or treatment of neonatal abstinence syndrome due to crystal methamphetamine. Additionally, no evidence based guidelines were identified regarding treatment or diagnosis of neonatal abstinence syndrome due to crystal methamphetamine. One limitation of the present report is the limited search dates (extended only to 2014). It is possible that relevant literature exists that was published more than five years ago and was excluded by the current date-limited search.
Conclusions and Implications for Decision or Policy Making
No relevant literature or evidence-based guidelines were identified regarding the clinical effectiveness of interventions or recommendations for diagnosis or treatment of neonatal abstinence syndrome due to crystal methamphetamine; therefore no conclusions regarding treatments or diagnostic tools for NAS can be provided.
There is a distinct lack of studies regarding diagnosis and treatment of NAS due to crystal methamphetamine. This gap in the literature precludes the creation of appropriate guidelines for health care providers who treat these patients. Future studies addressing this condition may help reduce uncertainty in diagnosis and treatment.
References
- 1.
Streetz
VN, Gildon
BL, Thompson
DF. Role of clonidine in neonatal abstinence syndrome: a systematic review.
Ann Pharmacother. 2016;50(4):301–310. [
PubMed: 26783353]
- 2.
- 3.
MacMullen
NJ, Dulski
LA, Blobaum
P. Evidence-based interventions for neonatal abstinence syndrome.
Pediatr Nurs. 2014;40(4):165–172. [
PubMed: 25269356]
- 4.
Liberati
A, Altman
DG, Tetzlaff
J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
J Clin Epidemiol. 2009;62(10):e1–e34. [
PubMed: 19631507]
Appendix 1. Selection of Included Studies
Appendix 2. Additional References of Interest
Other Reports
Reviews
Oei
JL. Adult consequences of prenatal drug exposure.
Intern Med J. 2018;48(1):25–31. [
PubMed: 29314518]
Kocherlakota, P. Neonatal abstinence syndrome.
Pediatrics. 2014;134(2). [
PubMed: 25070299]
Clinical Practice Guidelines – Methodology Uncertain
About the Series
CADTH Rapid Response Report: Summary with Critical Appraisal
Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
Suggested citation:
Treatment of neonatal abstinence syndrome due to crystal methamphetamine: a review of clinical effectiveness and guidelines. Ottawa: CADTH; 2019 Jun. (CADTH rapid response report: summary with critical appraisal).
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