Systematic mixed?study review of nonpharmacological management of neonatal abstinence syndrome

Background: Neonatal abstinence syndrome is a multi-system disorder resulting from exposure to maternal addictive substance use in pregnancy. Withdrawal is characterized by neonatal tremors, feeding difficulties and sleep disruption. The aim of this systematic review is to explore the non-pharmacological management of infants at risk of neonatal abstinence syndrome following prenatal exposure. Methods: A systematic mixed study review was conducted. A search of CINAHL, MEDLINE, AMED, PsycArticles, PsycInfo and Web of Science was performed for relevant articles published between January 2007 and June 2018. Quantitative and qualitative data were extracted, and thematic analysis undertaken. The findings were synthesized as a narrative summary. Results: Fourteen studies were included in the review of which nine were quality improvement initiatives and five explored complementary therapies. The most common components of non-pharmacological management were consolation therapy and rooming-in of mother and baby. Implementation strategies incorporated family integrated care and practitioner training in the evaluation of neonatal withdrawal. When non- pharmacological management was applied there was a reduction in the need for pharmacotherapy and a shorter hospital stay for neonates. Potential barriers to effective management included unreliable assessment tools, judgemental practitioner attitudes and limited breastfeeding promotion. Conclusion: Providing and optimizing non-pharmacological management for the infant at risk of neonatal abstinence syndrome improves outcomes by reducing their length of hospital stay and the need for pharmacotherapy

A look behind closed doors: interaction of persistent viruses with dendritic cells.

International audiencePersistent infections with HIV, hepatitis B virus and hepatitis C virus are major causes of morbidity and mortality worldwide. As sentinels of the immune system, dendritic cells (DCs) are crucial for the generation of protective antiviral immunity. Recent advances in our understanding of the role of DCs during infection with these viruses provide insights into the mechanisms used by these viruses to exploit DC function and evade innate and adaptive immunity. In this Review we highlight the current knowledge about the interaction between DCs and these viruses and the underlying mechanisms that might influence the outcome of viral infections