Neonatal Withdrawal Following in Utero Exposure to Kratom

Abstract

In recent years, the clinical definition of neonatal abstinence syndrome (NAS) has been expanded to describe neonates experiencing withdrawal due to in utero exposure to numerous neuroactive substances, not exclusively opioids. Complex NAS cases involving exposure to multiple and unusual narcotics have become widespread. Kratom is one such substance. It is extracted from tropical tree leaves, and can be used both as a recreational drug and to mitigate opioid withdrawal. Although kratom may potentially serve as a viable opioid alternative, its activity and the consequences of controlled use are largely unstudied, particularly in the pregnant population. A newborn male infant was not initially identified as being at risk for withdrawal due to no maternal admission of substance use and maternal urine drug screen was negative. On the first day of life (DOL), the neonate was observed to exhibit significant signs of withdrawal including high-pitched crying, facial grimacing, irregular respiratory pattern, mottling, and mild undisturbed tremors. Upon interview with the mother it was noted that there was heavy caffeine use, daily cigarette smoking, daily use of the “herbal alternative” (kratom) throughout the pregnancy. In this report, we present a case of NAS precipitated by  in utero exposure to kratom, discuss the present body of research regarding kratom and consider potential implications of escalating kratom use on the incidence and severity of NAS. For this prenatally exposed neonate, clonidine was successfully used to control withdrawal symptoms. Int J Clin Pediatr. 2018;7(4):55-58 doi: https://doi.org/10.14740/ijcp317w