Hospital morphine preparation for abstinence syndrome in newborns exposed to buprenorphine or methadone

Colombini, Nathalie; Élias, Riad; Busuttil, Muriel; Dubuc, Myriam; Einaudi, Marie-Ange; Buès-Charbit, M.

doi:10.1007/s11096-007-9176-1

Cited by 26 publications

(38 citation statements)

References 28 publications

(45 reference statements)

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“…Of 1111 citations identified, 140 full‐text papers were assessed for eligibility, and 18 studies 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 (reported in 23 papers 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52) satisfied our inclusion criteria (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…The only three RCTs 19, 20, 21 (six papers 19, 20, 21, 50, 51, 52) that have been conducted to date were included (223 participants; published 2005–10) (Supporting information, Table S2). Fifteen OBSs 18, 34, 35, 36, 37, 38, 39, 41, 42, 43, 44, 45, 46, 47, 48 (17 papers) 18, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 enrolled a total of 1923 participants in prospective 18, 34, 35, 36, 37, 38, 39, 41, 42, 45, 46, 47 ( n = 12) or retrospective 43, 44, 48 ( n = 3) cohort studies published 2001–15. No case–control studies were identified.…”

Section: Resultsmentioning

confidence: 99%

“…Statistical heterogeneity was low among the main analyses except for growth outcomes [birth weight (two RCTs, I 2 = 50%); LBW (two OBSs, I 2 = 62%); and SGA (two OBSs, I 2 = 50%)]. ROB was rated medium for each RCT ( n = 3, Supporting information, Table S3) and medium ( n = 9) 18, 38, 39, 40, 41, 42, 43, 48, 49 or high ( n = 8) 34, 35, 36, 37, 44, 45, 46, 47 for all OBSs (Supporting information, Table S4). Twelve OBSs assessed the balance between treatment groups for various confounding factors at study enrollment (Supporting information, Table S2), but only two OBSs adjusted for confounding factors in estimating treatment effects 39, 48.…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 41, 42, 43, 44, 45, 47, 48 reported preterm births. The effect estimate from three RCTs 19, 20, 21 indicated lower risk of preterm birth for BUP compared with MET.…”

Section: Resultsmentioning

confidence: 99%

“…EGA = estimated gestational age.aWe included one study that treated women with an abuse‐deterrent combination buprenorphine (BUP)–naloxone formulation 44, but excluded it from quantitative analyses.bPreterm birth was defined as < 36 completed weeks gestation in Colombini 2008 37.cSGA was defined as birth weight below: (a) 2 standard deviations from the sex‐ and gestational‐week specific mean value (Jones 2010 19; Kakko 2008 39); (b) 10th percentile of the sex‐ and gestational‐week specific mean value (Siedentopf 2004 47); or (c) the 5th percentile of the sex‐ and gestational‐week specific mean value (Brulet 2007 36; Meyer 2015 43). …”

Section: Methodsmentioning

confidence: 99%

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Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

et al. 2016

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AimsTo assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder.MethodsWe searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid‐dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random‐effects models for each outcome with two or more studies.ResultsThree RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta‐analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.ConclusionsModerately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

et al. 2016

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HIV‐1 alters neural and glial progenitor cell dynamics in the central nervous system: Coordinated response to opiates during maturation

Hahn

Podhaizer

Hauser

et al. 2012

Glia

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HIV-associated neurocognitive disorders (HAND) are common sequelae of HIV infection, even when viral titers are well controlled by anti-retroviral therapy. Evidence in patients and animal models suggests that neurologic deficits are increased during chronic opiate exposure. We have hypothesized that CNS progenitor cells in both adult and developing CNS are affected by HIV infection, and that opiates exacerbate these effects. To examine this question, neural progenitors were exposed to HIV-1 Tat1-86 in the developing brain of inducible transgenic mice and in vitro. We examined whether Tat affected the proliferation or balance of progenitor populations expressing nestin, Sox2, and Olig2. Disease relevance was further tested by exposing human-derived progenitors to supernatant from HIV-1 infected monocytes. Studies concentrated on striatum, a region preferentially targeted by HIV and opiates. Results were similar among experimental paradigms. Tat or HIV exposure reduced the proliferation of undifferentiated (Sox2+) progenitors and oligodendroglial (Olig2+) progenitors. Co-exposure to morphine exacerbated the effects of Tat or HIV-1SF162 supernatant, but partially reversed HIV-1IIIB supernatant effects. Populations of Sox2+ and Olig2+ cells were also reduced by Tat exposure, although progenitor survival was unaffected. In rare instances, p24 immunolabeling was detected in viable human progenitors by confocal imaging. The vulnerability of progenitors is likely to distort the dynamic balance among neuron/glial populations as the brain matures, perhaps contributing to reports that neurologic disease is especially prevalent in pediatric HIV patients. Pediatric disease is atypical in developed regions, but remains a serious concern in resource-limited areas where infection occurs commonly at birth and through breast-feeding.

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Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women

et al. 2017

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Pregnant women with opioid use disorder can be treated with methadone, buprenorphine, or naltrexone to reduce opioid use and improve retention to treatment. In this review, we compare the pregnancy outcomes of methadone, buprenorphine, and naltrexone in clinical trials and discuss the potential behavioral and developmental effects of these agents seen in offspring in animal studies. Important clinical considerations in the management of opioid use disorder in pregnant women and their infants are also discussed. Outside of pregnancy, buprenorphine is used in combination with naloxone to reduce opioid abuse and diversion. During pregnancy, however, the use of buprenorphine as a single agent is preferred to prevent prenatal naloxone exposure. Both methadone and buprenorphine are widely used to treat opioid use disorder; however, compared with methadone, buprenorphine is associated with shorter treatment duration, less medication needed to treat neonatal abstinence syndrome (NAS) symptoms, and shorter hospitalizations for neonates. Despite being the standard of care, medication-assisted treatment with methadone or buprenorphine is still underused, making it apparent that more options are necessary. Naltrexone is not a first-line treatment primarily because both detoxification and an opioid-free period are required. More research is needed to determine naltrexone safety and benefits in pregnant women. Animal studies suggest that changes in pain sensitivity, developmental processes, and behavioral responses may occur in children born to mothers receiving methadone, buprenorphine, or naltrexone and is an area that warrants future studies.

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Hospital morphine preparation for abstinence syndrome in newborns exposed to buprenorphine or methadone

Cited by 26 publications

References 28 publications

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

HIV‐1 alters neural and glial progenitor cell dynamics in the central nervous system: Coordinated response to opiates during maturation

Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women

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