Am J Perinatol 2018; 35(04): 405-412
DOI: 10.1055/s-0037-1608634
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Neonatal Abstinence Syndrome Treatment with Sublingual Buprenorphine versus Conventional Opioids

Eric S. Hall
1   Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2   Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Ward R. Rice
1   Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2   Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Alonzo T. Folger
2   Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
3   Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
,
Scott L. Wexelblatt
1   Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
2   Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
› Author Affiliations
Funding This study was supported by institutional funding from the Cincinnati Children's Hospital Medical Center Perinatal Institute.
Further Information

Publication History

03 August 2017

28 September 2017

Publication Date:
07 November 2017 (online)

Abstract

Objective The objective of this study was to compare duration of opioid treatment and length of stay outcomes for neonatal abstinence syndrome (NAS) using sublingual buprenorphine versus traditional weaning with methadone or morphine.

Study Design This retrospective cohort analysis evaluated infants treated for NAS at a single community hospital from July 2013 through June 2017. A standardized weaning protocol was introduced in June 2015, allowing for treatment with sublingual buprenorphine regardless of type of intrauterine opioid exposure. General linear models were used to calculate adjusted mean duration of opioid treatment and length of hospitalization with 95% confidence intervals for infants treated with buprenorphine compared with traditional weaning with either methadone or morphine.

Results A total of 360 infants were treated with either buprenorphine (n = 174) or a traditional opioid (n = 186). Infants treated with buprenorphine experienced a 3.0-day reduction in opioid treatment duration of 7.4 (6.3–8.5) versus 10.4 (9.3–11.5) days (p < 0.001) and a 2.8-day reduction in length of stay of 12.4 (11.3–13.6) versus 15.2 (14.1–16.4) days (p < 0.001).

Conclusion Our study provides an independent confirmation that among infants experiencing NAS following a wide array of intrauterine opioid exposures, buprenorphine weaning supports a shortened treatment duration compared with conventional weaning agents.

 
  • References

  • 1 McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med 2016; 375 (25) 2468-2479
  • 2 Hudak ML, Tan RC. ; Committee on Drugs; Committee on Fetus and Newborn; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012; 129 (02) e540-e560
  • 3 Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol 2015; 35 (08) 650-655
  • 4 Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012; 307 (18) 1934-1940
  • 5 Patrick SW, Kaplan HC, Passarella M, Davis MM, Lorch SA. Variation in treatment of neonatal abstinence syndrome in US children's hospitals, 2004-2011. J Perinatol 2014; 34 (11) 867-872
  • 6 Hall ES, Wexelblatt SL, Crowley M. , et al; OCHNAS Consortium. Implementation of a neonatal abstinence syndrome weaning protocol: a multicenter cohort study. Pediatrics 2015; 136 (04) e803-e810
  • 7 Hall ES, Isemann BT, Wexelblatt SL. , et al. A cohort comparison of buprenorphine versus methadone treatment for neonatal abstinence syndrome. J Pediatr 2016; 170: 39-44.e1
  • 8 Hall ES, Meinzen-Derr J, Wexelblatt SL. Cohort analysis of a pharmacokinetic-modeled methadone weaning optimization for neonatal abstinence syndrome. J Pediatr 2015; 167 (06) 1221-5.e1
  • 9 Moore JN, Gastonguay M, Adeniyi-Jones SC, Moody DE, Kraft WK. Population Pharmacokinetic and Pharmacodynamic Analysis of Buprenorphine for the Treatment of Neonatal Abstinence Syndrome. Department of Pharmacology and Experimental Therapeutics Posters. 2017. Available at: http://jdc.jefferson.edu/petposters/4 . Accessed July 22, 2017
  • 10 Kraft WK, Gibson E, Dysart K. , et al. Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial. Pediatrics 2008; 122 (03) e601-e607
  • 11 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
  • 12 The Ohio Perinatal Quality Collaborative. Enteral Methadone or Morphine Protocol for Neonatal Abstinence Syndrome (NAS) from Maternal Exposure. 2015 . Available at: https://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/NAS/OPQC%20Recommended%20NAS%20Protocol%20Changes%202017.pdf . Accessed May 12, 2017
  • 13 Hall ES, Wexelblatt SL, Crowley M. , et al; OCHNAS Consortium. A multicenter cohort study of treatments and hospital outcomes in neonatal abstinence syndrome. Pediatrics 2014; 134 (02) e527-e534
  • 14 Finnegan LP, Connaughton Jr JF, Kron RE, Emich JP. Neonatal abstinence syndrome: assessment and management. Addict Dis 1975; 2 (1-2): 141-158
  • 15 Wexelblatt SL, Ward LP, Torok K, Tisdale E, Meinzen-Derr JK, Greenberg JM. Universal maternal drug testing in a high-prevalence region of prescription opiate abuse. J Pediatr 2015; 166 (03) 582-586
  • 16 Grim K, Harrison TE, Wilder RT. Management of neonatal abstinence syndrome from opioids. Clin Perinatol 2013; 40 (03) 509-524
  • 17 Dahan A, Yassen A, Romberg R. , et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth 2006; 96 (05) 627-632
  • 18 Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2014; (02) CD002207
  • 19 Jones HE, Kaltenbach K, Heil SH. , et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med 2010; 363 (24) 2320-2331
  • 20 Unger A, Jagsch R, Jones H. , et al. Randomized controlled trials in pregnancy: scientific and ethical aspects. Exposure to different opioid medications during pregnancy in an intra-individual comparison. Addiction 2011; 106 (07) 1355-1362