Management of Neonatal Abstinence Syndrome

Abstract

Research Article| September 01 2017 Management of Neonatal Abstinence Syndrome AAP Grand Rounds (2017) 38 (3): 27. https://doi.org/10.1542/gr.38-3-27 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Management of Neonatal Abstinence Syndrome. AAP Grand Rounds September 2017; 38 (3): 27. https://doi.org/10.1542/gr.38-3-27 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: buprenorphine, morphine, neonatal abstinence syndrome, length of stay Source: Kraft WK, Adeniyi-Jones SC, Chervoneva I, et al. Buprenorphine for the treatment of the neonatal abstinence syndrome. N Engl J Med. 2017; 376(24): 2341– 2348; doi: https://doi.org/10.1056/NEJMoa1614835Google Scholar Investigators from Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and Icahn School of Medicine at Mount Sinai, New York City, conducted a randomized, double-blind, placebo-controlled trial to compare the effectiveness and safety of oral morphine and sublingual buprenorphine for the treatment of neonatal abstinence syndrome (NAS). Full-term newborns (≥37 weeks’ gestation) who had been exposed to opioids in utero and had signs of NAS were enrolled in the study and were randomized to receive either morphine every 4 hours or buprenorphine every 8 hours; all study neonates also received placebo resembling the active medications to maintain blinding. Randomization was stratified by the mother’s intention to breastfeed. Criteria for initiating, weaning, and discontinuing the study drug were based on scores on the Maternal Opioid Treatment: Human Experimental Research, or MOTHER, NAS scale—a modified Finnegan scoring instrument. Phenobarbital was added if maximum doses of buprenorphine (60 μg/kg/d) or morphine (1.2 mg/kg/d) were reached in a newborn. The primary study outcome was duration of drug treatment for NAS. Secondary outcomes included length of hospital stay and need for supplemental phenobarbital. Safety measures included changes in weight from birth and respiratory rate, as well as adverse events. Outcomes were compared in newborns assigned to the morphine or buprenorphine treatment groups. Data were analyzed in 63 neonates, including 33 who received buprenorphine and 30 who were randomized to morphine. Median duration of treatment was 15 days for those in the buprenorphine group and 28 days for those randomized to morphine (P < .001). Length of hospital stay was also significantly shorter for neonates receiving buprenorphine than for those in the morphine group (median of 21 days and 33 days, respectively; P < .001). Five newborns (15%) in the buprenorphine group required supplemental phenobarbital, versus 7 (23%) of those randomized to the morphine group (P = .36). There were no significant differences in rates of adverse events. The respiratory rates of neonates assigned to receive morphine were lower than those of neonates in the buprenorphine group (P =. 02), although all respiratory rates were in the normal range. At 7 days, the reduction in weight from birth was significantly greater in those receiving buprenorphine, but there were no significant differences in change from birth weight among newborns in the 2 treatment groups at days 14, 21, and 28. The authors conclude that the use of buprenorphine to treat NAS in neonates resulted in shorter lengths of treatment and hospital stay than treatment with morphine. Dr Mintzer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Opioid withdrawal after in utero exposure causes a constellation of signs and symptoms, including irritability, tremors, poor feeding, and loose stools.... You do not currently have access to this content.