Management of neonatal abstinence syndrome in neonates born to opioid maintained women

• Published in: Drug and alcohol dependence Vol. 87; no. 2; pp. 131 - 138
• Main Authors: Ebner, Nina, Rohrmeister, Klaudia, Winklbaur, Bernadette, Baewert, Andjela, Jagsch, Reinhold, Peternell, Alexandra, Thau, Kenneth, Fischer, Gabriele
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 16-03-2007; Elsevier Science
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Apgar Score; Biological and medical sciences; Drug addiction; Female; Gestational Age; Humans; Infant, Newborn; Maintenance therapy; Male; Medical sciences; Methadone - therapeutic use; Morphine - therapeutic use; Neonatal abstinence syndrome; Neonatal abstinence syndrome (NAS); Neonatal Abstinence Syndrome - drug therapy; Newborn babies; Opiates; Opioid dependence; Opioid-Related Disorders; Patient Selection; Phenobarbital - therapeutic use; Pregnancy; Pregnancy Complications - psychology; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Toxicology; Treatment methods; Withdrawal symptoms; Pregnancy; Opioid dependence; Maintenance therapy; Neonatal abstinence syndrome (NAS); Human; Drug addiction; Neonatal; Psychology; Opiates; Management; Abstinence; Syndrome; Newborn; Addiction; Maintenance treatment; Dependence; Adult; Female; Woman; Psychiatry
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2006.08.024

Abstract Neonates born to opioid-maintained mothers are at risk of developing neonatal abstinence syndrome (NAS), which often requires pharmacological treatment. This study examined the effect of opioid maintenance treatment on the incidence and timing of NAS, and compared two different NAS treatments (phenobarbital versus morphine hydrochloride). Fifty-three neonates born to opioid-maintained mothers were included in this study. The mothers received methadone ( n = 22), slow-release oral morphine ( n = 17) or buprenorphine ( n = 14) throughout pregnancy. Irrespective of maintenance treatment, all neonates showed APGAR scores comparable to infants of non-opioid dependent mothers. No difference was found between the three maintenance groups regarding neonatal weight, length or head circumference. Sixty percent ( n = 32) of neonates required treatment for NAS [68% in the methadone-maintained group ( n = 15), 82% in the morphine-maintained group ( n = 14), and 21% in the buprenorphine-maintained group ( n = 3)]. The mean duration from birth to requirement of NAS treatment was 33 h for the morphine-maintained group, 34 h for the buprenorphine-maintained group and 58 h for the methadone-maintained group. In neonates requiring NAS treatment, those receiving morphine required a significantly shorter mean duration of treatment (9.9 days) versus those treated with phenobarbital (17.7 days). Results suggest that morphine hydrochloride is preferable for neonates suffering NAS due to opioid withdrawal.