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Withdrawal symptoms in a neonate associated with maternal pentazocine abuse
324
Letters to the Editor
has been observed and confirmed by roentgenograms during the active process in.a parent and child. Other reported familial cases have occurred in siblings, or with parental involvement suggested by history and/or the presence of residual bony deformities. William H. Langewisch, M.D. Rockford School of Medicine 1601 Parkview A re. Rockford, IlL 61101 REFERENCES 1. R6ske G: Eine eigenartige Knocheuerkrankung im Saulingsalter, Monnatsschr Kinderheilk 47:385, 1930. 2. Valler K, and Taur A: Zur ~tiologie der infantilen Kortikalen hyperostose (Caffey-Syndrom), Fortschr Geb ROntgenstr 79:446, 1953. 3. Clemett AR, and Williams JH: The familial occurrence of infantile cortical hyperostosis, Radiology 80:409, 1963. 4. Pajewski M, and Vure E: Late manifestations of infantile cortical hyperostosis (Caffey's disease), Br J Radiol 40:90, 1967. 5. Sherman MS, and Hellyer DT: Infantile cortical hyperostosis; review of literature and report of five cases, Am J Roentgenol Rad Ther 63:212, 1950.
Withdrawal symptoms in a neonate associated with maternal pentazocine abuse To the Editor: Two recent case reports in THE JOURNAL have suggested a relationship between maternal pentazocine (Talwin) abuse and neonatal withdrawal symptoms?. : A third case with toxicologic studies of maternal urine and serum is presented.
The Journal of Pediatrics August 1975
taken other medication in excess but this was unsubstantiated. The mother admitted taking 50 mg of pentazocine as often as every 4 hours during the pregnancy, but she denied taking other drugs. Neonatal pentazocine withdrawal was suspected. Paragoric was given to the infant for 48 hours after which time she was markedly improved. No signs suggestive of withdrawal were noted after 72 hours of onset. Antibiotics were discontinued after five days and the infant discharged at 7 days of age. Follow-up evaluation at 3 weeks and 6 months of age was unremarkable. Urine and serum were obtained from the mother 12 hours after onset of the infants symptoms (two days after delivery). The mother had received 50 mg doses of pentazocine five and 12 hours after delivery but none thereafter. Toxicologic studies on these specimens were negative, except pentazocine was detected in the serum and urine by radioimmunoassay at a concentration of 13 and 400 ng/ml, respectively. DISCUSSION The infant's course is most consistent with withdrawal? The presence of pentazocine in the maternal urine and serum may reflect primarily postnatally administered drug, but the absence of other drugs in these specimens and the history of pentazocine abuse support the previously suspected association between maternal pentazocine abuse and neonatal withdrawal symptoms. Thomas O. Reeds, M.D., F.A.A.P. Kootenai Memorial Hospital Coeur d'Alene, Idaho 83814 REFERENCES 1. Goetz RL, and Bain RV: Neonatal withdrawal symptoms associated with maternal use of pentazocine, J PED1ATR 84:887, 1974. 2. Scanlon JW: Pentazocine and neonatal withdrawal symptoms, J PEDIAXR85:735, 1974. 3. Rothsteim P, and Gould JB: Born with a habit, Infants of drug addicted mothers, Pediatr Clin North Am 21:307, 1974.
CASE REPORT A 24-year-old white female was admitted to the hospital at 37 weeks' gestation in active labor; she had a temperature of 104 ~ F and meconium-stained amniotic fluid. She delivered a normal appearing 2,254-gm female infant 4 hours later. After cultures were obtained, intramuscular kanamycin and ampicillin were administered to the infant. The infant's course was unremarkable until 11/2 days of age when the following appeared: jitteriness, intermittent rapid respirations, eye blinking, liquid stools, vomiting, fist chewing, clusters of yawning and sneezing, and abdominal distention. Complete blood count, electrolytes, fiat plate of the abdomen, and serial calcium and glucose determinations were within normal limits. Cultures done at the time of delivery indicated over 100,000 colonies of Escherichia coli in the mother's urine. Infant and maternal blood cultures were negative and surface cultures of the infant were unremarkable as was microscopic examination of the placenta. The mother was known to many physicians in the local area because of her frequent requests for pentazocine for pain apparently related to injuries in a motorcycle accident two years previously. Physical dependence on pentazocine was suspected by these physicians. A relative suspected that the mother had
Pediatric hospital discharge summary To the Editor: We read with interest the description by Swender and associates 1 of the pediatric discharge summary utilized in their institution. We agree that this is a natural outgrowth of the problem-oriented medical record. We have developed a form with a similar purpose (Figs. 1 and 2). In addition, we have included other information and data which relate to immunizations, screening tests, and pediatric counseling. The form may be used as a teaching tool calling attention to areas of pediatric care which are considered essential, although not necessarily related to the acute problems which precipitated the hospitalization. Discharge forms are completed by the intern and/or students and reviewed by the attending pediatrician. The pertinent data can be
Letters to the Editor
has been observed and confirmed by roentgenograms during the active process in.a parent and child. Other reported familial cases have occurred in siblings, or with parental involvement suggested by history and/or the presence of residual bony deformities. William H. Langewisch, M.D. Rockford School of Medicine 1601 Parkview A re. Rockford, IlL 61101 REFERENCES 1. R6ske G: Eine eigenartige Knocheuerkrankung im Saulingsalter, Monnatsschr Kinderheilk 47:385, 1930. 2. Valler K, and Taur A: Zur ~tiologie der infantilen Kortikalen hyperostose (Caffey-Syndrom), Fortschr Geb ROntgenstr 79:446, 1953. 3. Clemett AR, and Williams JH: The familial occurrence of infantile cortical hyperostosis, Radiology 80:409, 1963. 4. Pajewski M, and Vure E: Late manifestations of infantile cortical hyperostosis (Caffey's disease), Br J Radiol 40:90, 1967. 5. Sherman MS, and Hellyer DT: Infantile cortical hyperostosis; review of literature and report of five cases, Am J Roentgenol Rad Ther 63:212, 1950.
Withdrawal symptoms in a neonate associated with maternal pentazocine abuse To the Editor: Two recent case reports in THE JOURNAL have suggested a relationship between maternal pentazocine (Talwin) abuse and neonatal withdrawal symptoms?. : A third case with toxicologic studies of maternal urine and serum is presented.
The Journal of Pediatrics August 1975
taken other medication in excess but this was unsubstantiated. The mother admitted taking 50 mg of pentazocine as often as every 4 hours during the pregnancy, but she denied taking other drugs. Neonatal pentazocine withdrawal was suspected. Paragoric was given to the infant for 48 hours after which time she was markedly improved. No signs suggestive of withdrawal were noted after 72 hours of onset. Antibiotics were discontinued after five days and the infant discharged at 7 days of age. Follow-up evaluation at 3 weeks and 6 months of age was unremarkable. Urine and serum were obtained from the mother 12 hours after onset of the infants symptoms (two days after delivery). The mother had received 50 mg doses of pentazocine five and 12 hours after delivery but none thereafter. Toxicologic studies on these specimens were negative, except pentazocine was detected in the serum and urine by radioimmunoassay at a concentration of 13 and 400 ng/ml, respectively. DISCUSSION The infant's course is most consistent with withdrawal? The presence of pentazocine in the maternal urine and serum may reflect primarily postnatally administered drug, but the absence of other drugs in these specimens and the history of pentazocine abuse support the previously suspected association between maternal pentazocine abuse and neonatal withdrawal symptoms. Thomas O. Reeds, M.D., F.A.A.P. Kootenai Memorial Hospital Coeur d'Alene, Idaho 83814 REFERENCES 1. Goetz RL, and Bain RV: Neonatal withdrawal symptoms associated with maternal use of pentazocine, J PED1ATR 84:887, 1974. 2. Scanlon JW: Pentazocine and neonatal withdrawal symptoms, J PEDIAXR85:735, 1974. 3. Rothsteim P, and Gould JB: Born with a habit, Infants of drug addicted mothers, Pediatr Clin North Am 21:307, 1974.
CASE REPORT A 24-year-old white female was admitted to the hospital at 37 weeks' gestation in active labor; she had a temperature of 104 ~ F and meconium-stained amniotic fluid. She delivered a normal appearing 2,254-gm female infant 4 hours later. After cultures were obtained, intramuscular kanamycin and ampicillin were administered to the infant. The infant's course was unremarkable until 11/2 days of age when the following appeared: jitteriness, intermittent rapid respirations, eye blinking, liquid stools, vomiting, fist chewing, clusters of yawning and sneezing, and abdominal distention. Complete blood count, electrolytes, fiat plate of the abdomen, and serial calcium and glucose determinations were within normal limits. Cultures done at the time of delivery indicated over 100,000 colonies of Escherichia coli in the mother's urine. Infant and maternal blood cultures were negative and surface cultures of the infant were unremarkable as was microscopic examination of the placenta. The mother was known to many physicians in the local area because of her frequent requests for pentazocine for pain apparently related to injuries in a motorcycle accident two years previously. Physical dependence on pentazocine was suspected by these physicians. A relative suspected that the mother had
Pediatric hospital discharge summary To the Editor: We read with interest the description by Swender and associates 1 of the pediatric discharge summary utilized in their institution. We agree that this is a natural outgrowth of the problem-oriented medical record. We have developed a form with a similar purpose (Figs. 1 and 2). In addition, we have included other information and data which relate to immunizations, screening tests, and pediatric counseling. The form may be used as a teaching tool calling attention to areas of pediatric care which are considered essential, although not necessarily related to the acute problems which precipitated the hospitalization. Discharge forms are completed by the intern and/or students and reviewed by the attending pediatrician. The pertinent data can be