OBJECTIVE: The study goal was to determine whether clonidine treatment of neonatal abstinence syndrome (NAS) would result in a better neurobehavioral performance compared with morphine.METHODS: This pilot study prospectively enrolled infants $35 weeks' gestational age admitted for treatment of NAS. After informed consent was obtained, infants were randomized to receive morphine (0.4 mg/kg per day) or clonidine (5 mg/kg per day) divided into 8 doses. A 25% dose escalation every 24 hours was possible per protocol (maximum of 1 mg/kg per day for morphine and 12 mg/kg per day for clonidine). After control of symptoms, the dose was tapered by 10% every other day. Clinical staff monitored infants by using Finnegan scoring. Masked research staff administered the NICU Network Neurobehavioral Scale (NNNS) at 1 week and at 2 to 4 weeks after initiation of treatment and the Bayley Scales III, and Preschool Language Scale IV, at 1-year adjusted age. Analyses included descriptive statistics, repeated measures analysis of variance, and Wilcoxon tests.RESULTS: Infants treated with morphine (n = 15) versus clonidine (n = 16) did not differ in birth weight or age at treatment. Treatment duration was significantly longer for morphine (median 39 days) than for clonidine (median 28 days; P = .02). NNNS summary scores improved significantly with clonidine but not with morphine. On subsequent assessment, those receiving clonidine had lower height of arousal and excitability (P , .05). One-year motor, cognitive, and language scores did not differ between groups.CONCLUSIONS: Clonidine may be a favorable alternative to morphine as a single-drug therapy for NAS. A multicenter randomized trial is warranted. WHAT'S KNOWN ON THIS SUBJECT:Increased central adrenergic activity occurs with opiate withdrawal. Clonidine is an effective drug as an adjunct to morphine in the treatment of neonatal abstinence syndrome. It is unclear whether clonidine is effective as single-drug therapy.WHAT THIS STUDY ADDS: Clonidine, a a 2 -adrenergic agonist, seems to be as effective as morphine when used as a single-drug therapy for neonatal abstinence syndrome. Its administration results in improvement in neurobehavioral performance.

This study describes swallow-breath interaction and phase of respiration with swallow during nonnutritive suck (NNS) in low-risk preterm infants. Suckle and swallow, thoracic motion, and airflow were measured in 16 infants during NNS. Logistic regression models were used to describe swallow-breath interaction and phase of respiration with swallow. One hundred seventy-six swallows occurred in 35 NNS periods. Swallow-breath interaction occurred as: central apnea (CA), obstructive apnea (OA), or attenuated respiration (AR). AR was associated with increased weeks post-first nipple feeding. OA occurred less often in males and with increased weeks post-first nipple feeding. In looking at the phase of respiration, more swallows occurred at beginning expiration with increased gestational age, increased weeks post-first nipple feed, and increased weeks before first nipple feed. More swallows occurred at midexpiration with more swallows per study, increased birth weight (BWT), and weeks before first nipple feed. Fewer swallows occurred at end expiration with increased weeks before first nipple feed. Fewer swallows occurred at midinspiration with increased swallows per study. Fewer swallows occurred at apnea with increasing BWT, more occurred with increased swallows per study. In low-risk preterm infants, swallow-breath interaction progresses from CA and OA to AR. The phase of respiration with swallow shows a maturation progression.

Pediatric early warning scores in an emergency department may be used in routine patient evaluation of illness severity and resource allocation, thereby positively impacting quality and safety in pediatric care. This prospective nursing study assessed the feasibility and reliability of pediatric early warning scores in a busy, inner-city, level 1 trauma center pediatric emergency department. The pediatric early warning scores demonstrated high interrater reliability (degree of agreement among scorers) (intraclass correlation coefficient = 0.91) and intrarater reliability (multiple repetitions by a single scorer) (intraclass correlation coefficient = 0.90).