EVIDENCE ± BASED NURSING

(EYES AND EARS)

SUBMITTED BY:
PUTONG, APRIL VERED
RENION, LOVELY
RIESGO JAMIE
SAMOY, JESSIELYN
VELASCO, MA LIEZL

BSN 219 Group 076

I. Clinical Question

Among pregnant mothers, do exposure to opiates (including substitute methadone)

and/or benzodiazepines affect the visual outcome of their infants?

II. Citations

Authors:

 R Hamilton1,
 L McGlone2,
 J R MacKinnon3,
 H C Russell3,
 M S Bradnam1,
 H Mactier

Source:
 Nursing Standard (NURS STAND), 2010 Jun 9-15; 24(40): 17 (1 ref)
 Br J Ophthalmol bjo.2009.169284Published Online First: 21 April 2010

EBSCO: Methadone exposure in utero puts children's eyesight in jeopardy.

BMJ JOURNALS: Ophthalmic, clinical and visual electrophysiological findings in

children born to mothers prescribed substitute methadone in pregnancy

III. Study Characteristics

Methadone is a narcotic pain reliever, similar to morphine. It also reduces withdrawal

symptoms in people addicted to heroin or other narcotic drugs without causing the
"high" associated with the drug addiction.

Methadone is used as a pain reliever and as part of drug addiction detoxification and
maintenance programs.

There are growing concerns regarding visual outcome of infants exposed to opiates
(including substitute methadone) and/or benzodiazepines in utero. We describe the
combined ophthalmology and visual electrophysiology findings in 20 infants and
children who had been exposed to substitute methadone and other drugs of misuse in
utero.
IV. Methodology

This was a descriptive case series of 20 patients, all of whom had been referred
to a pediatric visual electrophysiology service because of concerns regarding visual
function, and all of whom had been exposed to methadone in utero.

All children underwent a full ophthalmic and orthotics examination as well as

visual electrophysiology testing deemed appropriate on an individual basis.

A review was undertaken of pediatric case notes and of maternal antenatal urine
toxicology.

V. Results of the Study

Ophthalmic abnormalities included reduced acuity (95%), nystagmus (70%), delayed

visual maturation (50%), strabismus (30%), refractive errors (30%), and cerebral visual
impairment (25%). Visual electrophysiology was abnormal in 60%.

A quarter of the children had associated neurodevelopmental abnormalities. The

majority of children with nystagmus (79%) had been treated for neonatal abstinence
syndrome (NAS).

VI. Author’s Conclusions

"Infants born to drug-misusing mothers prescribed methadone in pregnancy are at risk

of a range of visual problems, the underlying causes of which are not clear. Those
infants with NAS severe enough to receive pharmaceutical treatment may be at
particular risk of developing nystagmus.

The inclusion of visual electrophysiology in comprehensive visual assessment of

children exposed to substance misuse in utero may help clarify the underlying causes
by differentiating abnormalities of retinal and cortical origin," the authors write.

VII. Applicability

This study is applicable to all pregnant mothers who take opiates as a means to relieve
pain during pregnancy
VIII. Reviewer’s Conclusion

This study will be helpful to all the pregnant mothers especially those who are taking
pain medications / opiates to control what they take to protect the offspring.

This study also show results of what is the harmful effects of the opiates to the infant
when taken during pregnancy

The results are also credible.

IX EVALUATION

 Safety:
There were risks involved in the study since some infants to be exposed to methadone.

 Competence of the Care Provider

The provider was able to get reasonable results within their time frame

 Acceptability
The study is acceptable because it showed reasonable results and will be helpful in the
future researches about opioids namely methadone

 Effectiveness
It showed effectiveness because those were included in the trial that that had less
exposure in methadone showed less visual impaired infants

 Appropriateness

The research is appropriate for pregnancy mothers to less intake of pain relievers for
the safety of their offspring.

 Efficiency

The study is not that efficient because a drug had to be used and should be taken by
mothers.

 Accessibility

The study is accessible to pregnant mothers, to be able to be aware of what medication

they should take for the protection of their offspring