Neonatal Abstinence Syndrome: Twelve Years of Experience at a Regional Referral Center

Abstract

Background:

Infants exposed to opiates antenatally display withdrawal symptoms after birth referred to as neonatal abstinence syndrome (NAS).

Patients:

A total of 366 newborns (166 females, 10 twins) from 361 mothers were diagnosed with NAS from 2000 to 2011 at a single large metropolitan referral center.

Methods:

Retrospective chart review of all newborn infants exposed to opiates in utero.

Results:

20% were premature (gestational age<37 weeks), 32% were small-for-gestational-age (<10^th percentile). 70% of infants (195/278) antenatally exposed to methadone (racemic methadone or levomethadone) required pharmacological treatment for 11 (1–55) days (median; range); however, 45% of infants (28/62) exposed to buprenorphine required pharmacological treatment for a median of only 5 (1–20) days (p=0.014). Pharmacological treatment of infants with phenobarbital (n=189) took a median of 9 (1–53) days, but treatment with morphine (n=39) took 19 (3–55) days (p<0.001). The median duration of hospitalization increased from 11 days in 2000–2004 to 19 days in 2008–2011 (p<0.001). The increased durations of neonatal hospitalization were associated with similar increases in the average dosages of maternal methadone.

Conclusion:

Use of buprenorphine, rather than methadone, for treatment of opiate-addicted pregnant women is associated with fewer and shorter neonatal withdrawal symptoms. The duration of hospitalization and treatment for NAS has increased over time.

Zusammenfassung

Hintergrund:Pränatal opiatexponierte Neugeborene zeigen nach der Geburt Entzugssymptome, die als neonatales Abstinenzsyndrom (NAS) bezeichnet werden.

Patienten:Im Zeitraum von 2000 bis 2011 wurde in einem regionalen Behandlungszentrum bei 366 Neugeborenen (166 weiblich, 10 Zwillinge) NAS diagnostiziert.

Methoden:Retrospektive Datenanalyse aller intrauterin opiatexponierten Neugeborenen.

Ergebnisse:20% der Patienten waren Frühgeborene (<37+0 SSW), 32% waren hypotroph (<10. Perzentile). 70% der Methadon (racemisches Methadon oder Levomethadon)-exponierten Neugeborenen (195/278) wurden für 11 (1–55) Tage (Median, Bereich) medikamentös behandelt, wohingegen nur 45% der Buprenorphin-exponierten Neugeborenen (28/62) nur 5 (1–20) Tage lang behandelt wurden (p=0,014). Die medikamentöse Behandlung mit Phenobarbital (n=189) dauerte 9 (1–53) Tage, die mit Morphin (n=39) 19 (3–55) Tage (p<0,001). Die mediane Behandlungsdauer nahm von 11 Tagen im Zeitraum von 2000–2004 bis auf 19 Tage in den Jahren 2008–2011 zu (p<0,001). Die zunehmende Behandlungsdauer war mit einer zunehmenden durchschnittlichen Tagesdosis der mütterlichen Methadonsubstitution assoziiert.

Schlussfolgerung:Die Substitution schwangerer Frauen mit Buprenorphin statt Methadon ist mit einem kürzeren und weniger schweren neonatalen Entzug assoziiert. Die Krankenhausaufenthalts- und Behandlungsdauer hat über den Beobachtungszeitraum zugenommen.

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