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Evidence summaries

Naloxone for Narcotic-Exposed Newborn Infants

There is insufficient evidence on benefits of naloxone to newborn infants with cardiorespiratory or neurological depression due to intrauterine exposure to opiate. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 9 studies with a total of 316 newborns in order to determine the effect of naloxone as a treatment for newborn infants who have been exposed in utero to opiate. The studies were undertaken in the 1970s or early 1980s. All participants were term newborn infants whose mothers had received pethidine (meperidine) for pain relief up to 6 hours prior to delivery. None examined the use of naloxone in infants who had been exposed to opiate in utero during pregnancy, for example due to maternal opiate-dependence. None of the studies specifically restricted participation to infants with cardiorespiratory or neurological depression following opiate exposure. There was some evidence that naloxone increased alveolar ventilation, however the reviewers did not find any data on the pre-specified primary outcomes of the review: admission to a neonatal unit or failure to establish breastfeeding.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment), by indirectness (differences between the outcomes of interest and those reported and differences between the population of interest and those studied), and by imprecise results (few outcome events).

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