To identify safe practices for management of chronic pain in pregnancy.
Retrospective chart review. We studied three commonly used opioid analgesics, compared neonatal outcomes for each of the agents, and identified potential contributing factors to the incidence of neonatal abstinence syndrome (NAS).
Neonatal outcomes were evaluated for all singletons delivered full term during a 42-month period, whose mothers met inclusion criteria and were taking codeine, hydrocodone, or oxycodone at any dosage three or more times per week.
The first phase was the retrospective chart review. Charts for every patient delivered by the perinatology practice for the specified time frame were individually reviewed for appropriateness for the study. Data were manually gathered onto an individual data sheet and de-identified. Once all charts were reviewed and data collected, data were coded and entered into a spreadsheet and analyzed for trends in neonatal outcomes using descriptive statistics. The second phase was to use the information collected combined with available data from other studies to create practice guidelines.
Outcomes examined included gestational age at delivery, birth weight, APGAR score, admission to the neonatal intensive care unit (NICU), diagnosis of NAS, length of stay, and treatment required. Maternal demographics were evaluated for any potential impact on neonatal outcome trends.
Thirty-one charts met criteria for the study. Nine neonates required a NICU admission. Length of NICU stay ranged from 2 to 10 days with an average NICU stay of 5 days. Two neonates required medical management with methadone. They were the only two with a diagnosis of NAS. Six of the nine were admitted for transient tachypnea of the newborn (TTN) and one was diagnosed as a poor feeder. Baseline data indicated that there is no association between NICU stay and agent used or between specific dosages or use of more than one agent. The study was limited by small sample size and multiple potential contributing factors to observed neonatal outcomes.
Conclusion/Implications for Nursing Practice
Obstetric and neonatal nurse and practitioners must become knowledgeable about the use of opioid analgesics in pregnancy. The findings of this study indicate the need for further research but support the judicious use of opioid analgesics at minimum effective doses. Thorough evaluation of the neonate at delivery for signs of NAS and TTN is warranted, and supportive care in a NICU environment can ease the transition to extrauterine life without opioid exposure.