1
|
Oji-Mmuo CN, Jones AN, Wu EY, Speer RR, Palmer T. Clinical care of neonates undergoing opioid withdrawal in the immediate postpartum period. Neurotoxicol Teratol 2021; 86:106978. [PMID: 33838247 DOI: 10.1016/j.ntt.2021.106978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/15/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Abstract
As the opioid epidemic escalates in westernized countries around the world, chronic opioid use during pregnancy has become a growing public health issue. There are increasing concerns that chronic maternal opioid use might adversely affect the developing fetal brain. Furthermore, the sudden discontinuation of the trans-placental opioid supply at birth puts newborns at acute risk for neonatal opioid withdrawal syndrome (NOWS). NOWS is a multi-system disorder that has been identified in approximately 50-80% of neonates exposed to opioids due to chronic maternal use. Clinically, NOWS affects the central and autonomic nervous systems as well as the gastrointestinal and respiratory tracts. The clinical features of NOWS include hyperirritability, high-pitched crying, restlessness, tremors, poor sleep, agitation, seizures, sweating, fever, poor feeding, regurgitation, diarrhea, and tachypnea. NOWS is currently diagnosed using a clinical scoring tool followed by toxicological confirmation of the presence of opioids in meconium or tissue specimens. The first-line treatments for NOWS are non-pharmacologic comfort measures. If these measures fail, neonates may be treated with opioids and/or sedatives. Since the severity of NOWS can be highly variable, it is quite difficult to predict which opioid-exposed neonates will require pharmacotherapy and prolonged hospitalization. Factors associated with maternal polysubstance use, including the use of illicit substances and tobacco, have been associated with the increased severity and duration of NOWS. Since neonates with NOWS are at increased risk for long-term adverse neurodevelopmental outcomes, ongoing monitoring beyond the neonatal period is essential.
Collapse
Affiliation(s)
- Christiana N Oji-Mmuo
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Hershey, PA, USA.
| | - Antoinette N Jones
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Emma Y Wu
- Penn State College of Medicine, Hershey, PA, USA
| | - Rebecca R Speer
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothy Palmer
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State College of Medicine, Hershey, PA, USA
| |
Collapse
|
2
|
Boschen KE, Keller SM, Roth TL, Klintsova AY. Epigenetic mechanisms in alcohol- and adversity-induced developmental origins of neurobehavioral functioning. Neurotoxicol Teratol 2018; 66:63-79. [PMID: 29305195 DOI: 10.1016/j.ntt.2017.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/11/2017] [Accepted: 12/26/2017] [Indexed: 12/13/2022]
Abstract
The long-term effects of developmental alcohol and stress exposure are well documented in both humans and non-human animal models. Damage to the brain and attendant life-long impairments in cognition and increased risk for psychiatric disorders are debilitating consequences of developmental exposure to alcohol and/or psychological stress. Here we discuss evidence for a role of epigenetic mechanisms in mediating these consequences. While we highlight some of the common ways in which stress or alcohol impact the epigenome, we point out that little is understood of the epigenome's response to experiencing both stress and alcohol exposure, though stress is a contributing factor as to why women drink during pregnancy. Advancing our understanding of this relationship is of critical concern not just for the health and well-being of individuals directly exposed to these teratogens, but for generations to come.
Collapse
Affiliation(s)
- K E Boschen
- Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, NC 27599, United States
| | - S M Keller
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States
| | - T L Roth
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States.
| | - A Y Klintsova
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States.
| |
Collapse
|
3
|
Sandtorv LB, Haugland S, Elgen I. Care and supportive measures in school-aged children with prenatal substance exposure. Scand J Public Health 2017; 45:782-788. [PMID: 28686142 DOI: 10.1177/1403494817713544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Prenatal exposure to substances, including alcohol, opiates, and a number of illicit drugs, may have a negative impact on fetal development. Studies have shown that substance exposure can influence a child's neurodevelopment and the need for care and supportive measures. In this study, we aimed to investigate the care status and the level of supportive measures in school-aged children prenatally exposed to alcohol and other substances. METHODS This study included children aged between 6 and 14 years who were referred to Haukeland University Hospital in Norway with developmental impairment and a history of prenatal substance exposure. Participants were classified according to their main prenatal exposure to either alcohol or other substances. Information on care status and supportive measures was obtained from medical records and participants' caregivers. We also compared the use of supportive measures for children placed into foster care before and after 1 year of age. RESULTS A total of 111 (87% of 128 referrals) eligible children participated in the study. Of these 111 children, 96 (86%) were in foster care, of whom 29 (30%) were placed into foster care during their first year of life and 83 out of 90 (92%) had supportive measures, including reinforced foster care and school or social support. CONCLUSIONS A high proportion of the sample lived in foster care and received supportive measures. Findings may reflect an increased need of care and support in school-aged children with prenatal substance exposure, highlighting the importance of awareness among caregivers and public agencies.
Collapse
Affiliation(s)
- Lisbeth B Sandtorv
- 1 Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,2 Department of Clinical Medicine, University of Bergen, Norway
| | - Siren Haugland
- 3 Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Norway
| | - Irene Elgen
- 1 Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,2 Department of Clinical Medicine, University of Bergen, Norway
| |
Collapse
|
4
|
Sandtorv LB, Hysing M, Rognlid M, Nilsen SA, Elgen IB. Mental Health in School-Aged Children Prenatally Exposed to Alcohol and Other Substances. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2017; 11:1178221817718160. [PMID: 29581703 PMCID: PMC5862371 DOI: 10.1177/1178221817718160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/26/2017] [Indexed: 11/17/2022]
Abstract
Prenatal exposure to substances can possibly influence a child's neurodevelopment and may impact on subsequent mental health. We investigated the mental health status of school-aged children referred to a pediatric hospital with a history of prenatal exposure to alcohol or other substances. Mental health was assessed using the Strengths and Difficulties Questionnaire and compared with a reference group. A total of 105 of 128 (82%) eligible children prenatally exposed to substances participated in the study, with 48 children exposed to alcohol and 57 to other substances. Strengths and Difficulties Questionnaire subscale mean scores, total difficulties scores, and total impact scores were statistically significantly higher in the group of exposed children, compared with the reference group. In this hospital-based population of school-aged children prenatally exposed to alcohol or other substances, the exposed group had an increased risk of mental health problems, compared with the reference group.
Collapse
Affiliation(s)
- Lisbeth Beate Sandtorv
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Malin Rognlid
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
5
|
Boschen KE, Klintsova AY. Neurotrophins in the Brain: Interaction With Alcohol Exposure During Development. VITAMINS AND HORMONES 2016; 104:197-242. [PMID: 28215296 PMCID: PMC5997461 DOI: 10.1016/bs.vh.2016.10.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fetal alcohol spectrum disorders (FASDs) are a result of the teratogenic effects of alcohol on the developing fetus. Decades of research examining both individuals with FASDs and animal models of developmental alcohol exposure have revealed the devastating effects of alcohol on brain structure, function, behavior, and cognition. Neurotrophic factors have an important role in guiding normal brain development and cellular plasticity in the adult brain. This chapter reviews the current literature showing that alcohol exposure during the developmental period impacts neurotrophin production and proposes avenues through which alcohol exposure and neurotrophin action might interact. These areas of overlap include formation of long-term potentiation, oxidative stress processes, neuroinflammation, apoptosis and cell loss, hippocampal adult neurogenesis, dendritic morphology and spine density, vasculogenesis and angiogenesis, and behaviors related to spatial memory, anxiety, and depression. Finally, we discuss how neurotrophins have the potential to act in a compensatory manner as neuroprotective molecules that can combat the deleterious effects of in utero alcohol exposure.
Collapse
Affiliation(s)
- K E Boschen
- University of Delaware, Newark, DE, United States
| | | |
Collapse
|
6
|
Lehikoinen A, Ordén MR, Heinonen S, Voutilainen R. Maternal drug or alcohol abuse is associated with decreased head size from mid-pregnancy to childhood. Acta Paediatr 2016; 105:817-22. [PMID: 27037638 DOI: 10.1111/apa.13416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/29/2016] [Accepted: 03/31/2016] [Indexed: 11/27/2022]
Abstract
AIM Maternal alcohol abuse is poorly recognised and causes developmental problems. This study explored the foetal central nervous systems (CNS), head circumference and psychomotor development of children exposed to drugs or alcohol during pregnancy up to 2.5 years of age. METHODS We recruited 23 pregnant women referred to Kuopio University Hospital, Finland, by their family doctor because of drug or alcohol abuse, and 22 control mothers. Foetal CNS parameters were measured by three-dimensional ultrasonography at the mean gestational age of 20 weeks and the Griffiths Mental Developmental Scales (GMDS), and anthropometric measurements were carried out at the mean ages of one and 2.5 years. RESULTS The exposed foetuses had decreased biparietal and occipito-frontal distances and head circumferences, but unchanged cerebellar volume at 20 weeks, and decreased head circumferences and length and height at birth, one and 2.5 years of age. They scored lower than the controls on the GMDS general quotient and the hearing, language and locomotor subscales at 2.5 years of age. CONCLUSION Maternal alcohol or drug exposure was associated with decreased head size from mid-pregnancy to childhood and reduced development at 2.5 years. Foetal head circumference at mid-pregnancy was a useful indicator of substance abuse affecting the CNS.
Collapse
Affiliation(s)
- Anni Lehikoinen
- Department of Pediatrics; University of Eastern Finland and Kuopio University Hospital; Kuopio Finland
| | - Maija-Riitta Ordén
- Department of Obstetrics and Gynecology; Kuopio University Hospital; Kuopio Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology; Kuopio University Hospital; Kuopio Finland
- Department of Obstetrics and Gynecology; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - Raimo Voutilainen
- Department of Pediatrics; University of Eastern Finland and Kuopio University Hospital; Kuopio Finland
| |
Collapse
|
7
|
Tylavsky FA, Kocak M, Murphy LE, Graff JC, Palmer FB, Völgyi E, Diaz-Thomas AM, Ferry RJ. Gestational Vitamin 25(OH)D Status as a Risk Factor for Receptive Language Development: A 24-Month, Longitudinal, Observational Study. Nutrients 2015; 7:9918-30. [PMID: 26633480 PMCID: PMC4690051 DOI: 10.3390/nu7125499] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/05/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023] Open
Abstract
Emerging data suggest that vitamin D status during childhood and adolescence can affect neurocognitive development. The purpose of this study was to investigate whether gestational 25(OH)D status is associated with early childhood cognitive and receptive language development. The Conditions Affecting Neurocognitive Development and Learning in Early Childhood Study (CANDLE) study enrolled 1503 mother-child dyads during the second trimester of healthy singleton pregnancies from Shelby County TN. Among 1020 participants of the total CANDLE cohort for whom 25(OH)D levels were available, mean gestational 25(OH)D level during the second trimester was 22.3 ng/mL (range 5.9–68.4), with 41.7% of values <20 ng/dL. Cognitive and language scaled scores increased in a stair-step manner as gestational 25(OH)D levels in the second trimester rose from <20 ng/dL, through 20–29.99 ng/dL, to ≥30 ng/dL. When controlling for socioeconomic status, race, use of tobacco products, gestational age of the child at birth, and age at the 2-year assessment, the gestational 25(OH)D was positively related to receptive language development (p < 0.017), but not cognitive or expressive language.
Collapse
Affiliation(s)
- Frances A Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN 38163-2181, USA.
- Urban Child Institute, 600 Jefferson Avenue, Memphis, TN 38105, USA.
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN 38163-2181, USA.
| | - Laura E Murphy
- Department of Psychiatry, University of Tennessee Health Science Center, 711 Jefferson Avenue, Memphis, TN 38163, USA.
- Boling Center for Developmental Disabilities, University of Tennessee Health Science Center, 711 Jefferson Avenue, Memphis, TN 38163-2167, USA.
| | - J Carolyn Graff
- Boling Center for Developmental Disabilities, University of Tennessee Health Science Center, 711 Jefferson Avenue, Memphis, TN 38163-2167, USA.
- College of Nursing, University of Tennessee Health Science Center, 711 Jefferson Avenue, Memphis, TN 38163, USA.
| | - Frederick B Palmer
- Boling Center for Developmental Disabilities, University of Tennessee Health Science Center, 711 Jefferson Avenue, Memphis, TN 38163-2167, USA.
- Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Memphis, TN 38103-2893, USA.
| | - Eszter Völgyi
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN 38163-2181, USA.
- Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Memphis, TN 38103-2893, USA.
| | - Alicia M Diaz-Thomas
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Memphis, TN 38103-2800, USA.
| | - Robert J Ferry
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Memphis, TN 38103-2800, USA.
- Department of Psychology, University of Memphis, 352 Psychology Building, Memphis, TN 38152-3370, USA.
| |
Collapse
|
8
|
Abstract
Most mental and substance use disorders begin during childhood and adolescence and are the leading cause of disability in this population. Prenatal and postnatal genetic, familial, social, and environmental exposures interact to influence risk for mental disorders and trajectories of cognitive development. Efforts to advance prevention and implement early interventions to reduce the burden of mental disorders require a global research workforce, intersectoral cooperation, attention to environmental contexts, and the development and testing of evidence-based interventions. The authors describe challenges and resources for building mental health research capacity that stands to influence children's mental health outcomes around the globe.
Collapse
Affiliation(s)
- Anna E. Ordóñez
- Office of Clinical Research, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, Maryland 20892, USA
| | - Pamela Y. Collins
- Office for Research on Disparities and Global Mental Health, NIMH, NIH, 6001 Executive Boulevard, Suite 6217, Bethesda, MD 20892, USA, Corresponding author.
| |
Collapse
|
9
|
Boschen KE, Criss KJ, Palamarchouk V, Roth TL, Klintsova AY. Effects of developmental alcohol exposure vs. intubation stress on BDNF and TrkB expression in the hippocampus and frontal cortex of neonatal rats. Int J Dev Neurosci 2015; 43:16-24. [PMID: 25805052 PMCID: PMC4442714 DOI: 10.1016/j.ijdevneu.2015.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/16/2022] Open
Abstract
Third trimester-equivalent alcohol exposure causes significant deficits in hippocampal and cortical neuroplasticity, resulting in alterations to dendritic arborization, hippocampal adult neurogenesis, and performance on learning tasks. The current study investigated the impact of neonatal alcohol exposure (postnatal days 4-9, 5.25 g/kg/day) on expression of brain-derived neurotrophic factor (BDNF) and the tropomyosin-related kinase B (TrkB) receptor in the hippocampal and frontal cortex of infant Long-Evans rats. Levels of BDNF protein were increased in the hippocampus, but not frontal cortex, of alcohol-exposed rats 24h after the last dose, when compared with undisturbed (but not sham-intubated) control animals. BDNF protein levels showed a trend toward increase in hippocampus of sham-intubated animals as well, suggesting an effect of the intubation procedure. TrkB protein was increased in the hippocampus of alcohol-exposed animals compared to sham-intubated pups, indicating an alcohol-specific effect on receptor expression. In addition, expression of bdnf total mRNA in alcohol-exposed and sham-intubated pups was enhanced in the hippocampus; however, there was a differential effect of alcohol and intubation stress on exon I- and IV-specific mRNA transcripts. Further, plasma corticosterone was found to be increased in both alcohol-exposed and sham-intubated pups compared to undisturbed animals. Upregulation of BDNF could potentially represent a neuroprotective mechanism activated following alcohol exposure or stress. The results suggest that alcohol exposure and stress have both overlapping and unique effects on BDNF, and highlight the need for the stress of intubation to be taken into consideration in studies that implement this route of drug delivery.
Collapse
Affiliation(s)
- K E Boschen
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States
| | - K J Criss
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States
| | - V Palamarchouk
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States
| | - T L Roth
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States
| | - A Y Klintsova
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE 19716, United States.
| |
Collapse
|
10
|
Abstract
OBJECTIVE Prenatal alcohol exposure (PAE) can cause fetal alcohol spectrum disorders (FASD) and associated neurodevelopmental impairments. It is uncertain which types of fine motor skills are most likely to be affected after PAE or which assessment tools are most appropriate to use in FASD diagnostic assessments. This systematic review examined which types of fine motor skills are impaired in children with PAE or FASD; which fine motor assessments are appropriate for FASD diagnosis; and whether fine motor impairments are evident at both "low" and "high" PAE levels. METHODS A systematic review of relevant databases was undertaken using key terms. Relevant studies were extracted using a standardized form, and methodological quality was rated using a critical appraisal tool. RESULTS Twenty-four studies met inclusion criteria. Complex fine motor skills, such as visual-motor integration, were more frequently impaired than basic fine motor skills, such as grip strength. Assessment tools that specifically assessed fine motor skills more consistently identified impairments than those which assessed fine motor skills as part of a generalized neurodevelopmental assessment. Fine motor impairments were associated with "moderate" to "high" PAE levels. Few studies reported fine motor skills of children with "low" PAE levels, so the effect of lower PAE levels on fine motor skills remains uncertain. CONCLUSIONS Comprehensive assessment of a range of fine motor skills in children with PAE is important to ensure an accurate FASD diagnosis and develop appropriate therapeutic interventions for children with PAE-related fine motor impairments.
Collapse
|
11
|
Klintsova AY, Hamilton GF, Boschen KE. Long-term consequences of developmental alcohol exposure on brain structure and function: therapeutic benefits of physical activity. Brain Sci 2012; 3:1-38. [PMID: 24961305 PMCID: PMC4061829 DOI: 10.3390/brainsci3010001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/01/2012] [Accepted: 12/10/2012] [Indexed: 02/07/2023] Open
Abstract
Developmental alcohol exposure both early in life and during adolescence can have a devastating impact on normal brain structure and functioning, leading to behavioral and cognitive impairments that persist throughout the lifespan. This review discusses human work as well as animal models used to investigate the effect of alcohol exposure at various time points during development, as well as specific behavioral and neuroanatomical deficits caused by alcohol exposure. Further, cellular and molecular mediators contributing to these alcohol-induced changes are examined, such as neurotrophic factors and apoptotic markers. Next, this review seeks to support the use of aerobic exercise as a potential therapeutic intervention for alcohol-related impairments. To date, few interventions, behavioral or pharmacological, have been proven effective in mitigating some alcohol-related deficits. Exercise is a simple therapy that can be used across species and also across socioeconomic status. It has a profoundly positive influence on many measures of learning and neuroplasticity; in particular, those measures damaged by alcohol exposure. This review discusses current evidence that exercise may mitigate damage caused by developmental alcohol exposure and is a promising therapeutic target for future research and intervention strategies.
Collapse
Affiliation(s)
- Anna Y Klintsova
- Department of Psychology, University of Delaware, Newark, DE 19716, USA.
| | - Gillian F Hamilton
- Department of Psychology, University of Delaware, Newark, DE 19716, USA.
| | - Karen E Boschen
- Department of Psychology, University of Delaware, Newark, DE 19716, USA.
| |
Collapse
|