scholarly journals Buprenorphine for the Treatment of Neonatal Abstinence Syndrome

2018 ◽  
Vol 34 (6) ◽  
pp. 266-272 ◽  
Author(s):  
Bryan M. Bishop
Keyword(s):  
Hospital Stay ◽  
Oral Morphine ◽  
Standard Of Care ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Single Center ◽  
Duration Of Treatment ◽  
Current Standard ◽  
Duration Of Hospital Stay ◽  
Oral Methadone

Objective: To summarize the available data for using buprenorphine in neonatal abstinence syndrome and discuss these data in context of the current standard of care therapies, oral morphine and oral methadone. Data Sources: A literature search was conducted using PubMed (1949-May 2018) and EMBASE (1980-May 2018). Combinations of the search terms “buprenorphine,” “neonatal,” and “neonatal abstinence syndrome” were used. Study Selection and Data Extraction: All full-length, English-language studies were included in this review. Data Synthesis: A total of 4 studies were included in this review including 1 retrospective cohort study, 2 prospective single-center open-label randomized trials, and 1 prospective single-center, double-blind study. Oral morphine was the comparator in 3 studies, and oral methadone was the comparator in one. Buprenorphine was associated with a significant reduction in duration of treatment in 3 of the 4 studies and was associated with a significant reduction in duration of hospital stay in 3 of the 4 studies. In the randomized, double-blinded trial, buprenorphine had a significantly reduced duration of treatment (15 vs 28 days, P < .001) and duration of hospital stay (21 vs 33 days, P < .001). The requirement of adjunct treatment was similar between groups in all 4 studies, and buprenorphine did not have any significant adverse reactions in comparison with morphine and methadone. Conclusions: Buprenorphine appears to be a safe option for treating neonatal abstinence syndrome that is potentially superior to the current standard of care therapies with respect to duration of treatment and hospital length of stay.

scholarly journals Ineffective morphine treatment regimen for the control of Neonatal Abstinence Syndrome in buprenorphine- and methadone-exposed infants

2012 ◽  
Vol 3 (4) ◽  
pp. 262-270 ◽  
Author(s):  
A. L. Gordon ◽  
O. V. Lopatko ◽  
R. R. Haslam ◽  
H. Stacey ◽  
V. Pearson ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Oral Morphine ◽  
Length Of Hospital Stay ◽  
Maternity Hospital ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Morphine Treatment ◽  
Opioid Agonist ◽  
Control Infant ◽  
Significant Difference

This study aimed to determine if morphine is effective in ameliorating Neonatal Abstinence Syndrome (NAS) symptoms to non-opioid-exposed control levels in methadone- and buprenorphine-exposed infants. A prospective, non-randomized comparison study with flexible dosing was undertaken in a large teaching maternity hospital in Australia. Twenty-five infants in the groups of buprenorphine-, methadone- and control non-opioid-exposed infants were compared (totaln= 75 infants). Oral morphine sulphate (1 mg/ml) was administered every 4 h to opioid agonist-exposed infants. Modified Finnegan Withdrawal Scale (MFWS) scores determined dosing: score of 8–10: 0.5 mg/kg/day, 11–13: 0.7 mg/kg/day and 14+: 0.9 mg/kg/day. Withdrawal score, amount of morphine administered and length of hospital stay, were used to assess NAS over a 4-week follow-up period. No controls achieved a score higher than 7 on the MFWS. There was no significant difference in the percentage of infants requiring treatment between methadone (60%) and buprenorphine (48%) infants. For treated infants, significantly (P< 0.01) more morphine was administered to methadone (40.07 ± 3.95 mg) compared with buprenorphine infants (22.77 ± 4.29 mg) to attempt to control NAS. Following treatment initiation, significantly more (P< 0.01) methadone (87%) compared with buprenorphine infants (42%) continued to exceed scoring thresholds for morphine treatment requirement, and non-opioid-exposed control infant scores. For treated infants, there was no significant difference in length of hospital stay between methadone and buprenorphine infants. Morphine treatment was not entirely effective in ameliorating NAS to non-opioid-exposed control symptom levels in methadone or buprenorphine infants. The regimen may be less effective in methadone compared with buprenorphine infants.

scholarly journals Rooming-in for Infants at Risk for Neonatal Abstinence Syndrome: Outcomes 5 Years following Its Introduction as the Standard of Care at One Hospital

2020 ◽  
Author(s):  
Adam Isaiah Newman ◽  
Dane Mauer-Vakil ◽  
Helen Coo ◽  
Lynn Newton ◽  
Emily Wilkerson ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hospital Stay ◽  
Pharmacological Treatment ◽  
Standard Care ◽  
Neonatal Intensive Care ◽  
Length Of Hospital Stay ◽  
Standard Of Care ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Lengths Of Stay

Objective The practice of rooming-in for opioid-dependent infants was introduced as the standard of care at our hospital following a pilot study which demonstrated that such infants had shorter lengths of stay and were less likely to require pharmacological treatment. We sought to determine whether these benefits have continued, and whether outcomes support continuing to use rooming-in as standard care. Study Design Opioid-dependent infants delivered at 36 weeks gestation or later between January 1, 2015, and December 31, 2019, were eligible for rooming-in. Charts were reviewed and data were extracted regarding maternal and infant conditions, whether neonatal pharmacological treatment was required, and total length of hospital stay. Outcomes were compared with two historical groups reported in a previous pilot study: 24 healthy near-term opioid-dependent newborns who were admitted directly to the neonatal intensive care unit (NICU) prior to the introduction of rooming-in (May 1, 2012–May 31, 2013), and 20 similar opioid-dependent infants who were the first to room-in at our hospital (September 1, 2013–September 30, 2014). Results Only 3.5% of 57 infants who roomed-in during the 5-year study period required pharmacological treatment, compared with 15% who roomed-in during the first year of the program's introduction and 83.3% who had been admitted directly to the NICU. The median length of stay remained 5 days for infants rooming-in, compared with 24 days for opioid-dependent infants in the cohort admitted to the NICU. Conclusion Early observations of the benefits of rooming-in on neonatal outcomes were sustained. Infants allowed to room-in were significantly less likely to require initiation of pharmacotherapy and a prolonged hospital stay than similar infants prior to the implementation of rooming-in as standard care. A large proportion of the infants who might have benefited from rooming-in required admission to the NICU for reasons other than neonatal abstinence syndrome (NAS). Key Points

Music therapy for infants with neonatal abstinence syndrome

2017 ◽  
Vol 9 (1) ◽  
pp. 37
Author(s):  
Jacinta Louise Calabro
Keyword(s):  
Weight Gain ◽  
Music Therapy ◽  
Hospital Stay ◽  
Alternative Treatment ◽  
Bonding Process ◽  
Neonatal Abstinence Syndrome ◽  
In Utero Exposure ◽  
Abstinence Syndrome ◽  
Treatment Interventions ◽  
Treatment Groups

Abstract Neonatal Abstinence Syndrome (NAS) occurs after significant in-utero exposure to opiates, such as methadone and heroin.  Infants with NAS are often hospitalized for 4-6 weeks in a special care nursery, which is both expensive and detrimental to the parent-child bonding process. This study trialled the effectiveness of recorded sedative music (RSM) and multimodal stimulation (MMS) for infants with NAS.  The infants were recruited by the hospitals alcohol drug and pregnancy team (ADAPT) and randomly allocated into one of 4 groups. The study hypothesised that infants in the treatment groups would experience a shorter hospital stay, higher weight gain, more parent visits, more days until medication began and less medication than control infants.  The study also hypothesised that the treatment infants would have lower NAS scores compared to control infants. Due to a small and skewed sample the hypotheses were not supported.  There were no significant results for any measure, although slight trends were noted for reduced crying and regular respiration for infants in the treatment groups.  These findings support previous research into alternative treatment interventions for infants with NAS.  It is suggested that RSM and MMS interventions can still be potentially useful interventions with this population. KeywordsNeonatal abstinence syndrome (NAS), music therapy, multimodal stimulation, recorded sedative music.

scholarly journals Pharmacokinetics of Oral Methadone in the Treatment of Neonatal Abstinence Syndrome: A Pilot Study

2015 ◽  
Vol 167 (6) ◽  
pp. 1214-1220.e3 ◽  
Author(s):  
Jason R. Wiles ◽  
Barbara Isemann ◽  
Tomoyuki Mizuno ◽  
Meredith E. Tabangin ◽  
Laura P. Ward ◽  
...  
Keyword(s):  
Pilot Study ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Oral Methadone

Oral Clonidine in the Management of Acquired Opioid Dependency

2013 ◽  
Vol 32 (6) ◽  
pp. 419-424 ◽  
Author(s):  
Michele J. Beaulieu
Keyword(s):  
Adverse Effects ◽  
Antihypertensive Agent ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Duration Of Treatment ◽  
Opioid Dependency ◽  
Pharmacologic Agent ◽  
Nasal Decongestant ◽  
Oral Clonidine

Clonidine is a nonnarcotic analgesic historically used as a nasal decongestant and more recently established as an antihypertensive agent in adults. Because of its sedative properties with few adverse effects, clonidine has also been reported to be an effective pharmacologic agent for the treatment of neonatal abstinence syndrome (NAS). The use of oral clonidine as a primary or secondary agent in the treatment of NAS has been found to reduce hospitalization and duration of treatment in this population.

scholarly journals A Retrospective Review Following the Addition of Clonidine to a Neonatal Abstinence Syndrome Treatment Algorithm

2021 ◽  
Vol 9 ◽  
Author(s):  
Mohammad Y. Bader ◽  
Nahla Zaghloul ◽  
Ashley Repholz ◽  
Nadia Nagy ◽  
Mohamed N. Ahmed ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Cumulative Dose ◽  
Medical Center ◽  
Treatment Algorithm ◽  
Length Of Hospital Stay ◽  
Dual Therapy ◽  
Morphine Sulfate ◽  
Neonatal Abstinence Syndrome ◽  
Cumulative Exposure ◽  
Abstinence Syndrome

Objective: To investigate the outcomes associated with the implementation of a neonatal abstinence syndrome (NAS) treatment algorithm utilizing dual therapy with morphine sulfate and clonidine in a level four neonatal intensive care unit (NICU).Study Design: A cohort of neonates (≥35 weeks gestation) born at an academic tertiary medical center between January 1, 2015 and December 31, 2018 who were diagnosed with NAS were retrospectively evaluated following the implementation of a new NAS treatment algorithm. Neonates were categorized in two groups based on if they were treated pre- or post-implementation of the protocol. The primary efficacy outcome was length of hospital stay. Secondary outcomes included the incidence of adverse drug reactions, length of treatment for NAS, and maximum as well as total cumulative dose of each medication used to treat NAS.Results: The implementation of this NAS treatment algorithm significantly reduced the length of hospital stay (30 days vs. 20 days, p = 0.001). In addition, there was a significant decrease in duration of morphine sulfate exposure as well as cumulative dose of morphine required to successfully treat a neonate with NAS in the post-implementation group (26 days vs. 15 days, p = 0.002 and 6.9 mg/kg vs. 3.4 mg/kg, p = 0.031).Conclusion: Addition of clonidine to morphine sulfate as initial therapy for NAS significantly reduced the cumulative exposure as well as duration of exposure to morphine sulfate compared to morphine monotherapy and decrease length of hospital stay.

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