Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome

BACKGROUND: Neonatal abstinence syndrome (NAS) is usually treated with opiate derivatives and supported with nonpharmacological treatment.METHODS: This prospective, randomized, controlled, blinded, single-center study was carried out between March 2009 and November 2014. Newborn infants diagnosed with NAS after maternal opioid substitution therapy were eligible for inclusion. Infants were randomly allocated to the acupuncture group (combining laser acupuncture and pharmacological therapy of morphine and phenobarbital) or control group (pharmacological therapy alone). Laser acupuncture was performed with a LABpen MED 10 (675 nm/10 mW) at 5 ear and 4 body acupuncture points, bilaterally, and sessions were repeated every day. The primary outcome measure was duration of oral morphine therapy for NAS. Secondary outcomes included highest single Finnegan score, time to highest single Finnegan score, maximum amount of oral morphine solution (in milliliters per kilogram and milligrams per kilogram), time to maximum amount of oral morphine solution, and length of hospital stay.RESULTS: Twenty-eight newborns (14 in each group) were eligible for analysis. Duration of oral morphine therapy was significantly reduced in the acupuncture group compared with the control group (28 vs 39 days, respectively, P = .019). In addition, we observed a significantly reduced length of hospital stay in the acupuncture group compared with the control group (35 days [interquartile range 25 to 47] vs 50 days [36 to 66], P = .048).CONCLUSIONS: Adjunctive laser acupuncture significantly reduced the duration of morphine therapy in newborns with NAS. WHAT'S KNOWN ON THIS SUBJECT:The impact of neonatal abstinence syndrome is of concern because the number of newborns showing symptoms of withdrawal after intrauterine drug exposure is increasing worldwide. Newborns developing neonatal abstinence syndrome require prolonged medical treatment and longer hospital admission after birth. WHAT THIS STUDY ADDS:This first randomized controlled trial presents data on newborns with neonatal abstinence syndrome treated with laser acupuncture. The findings suggest that adjuvant laser acupuncture has the potential to reduce duration of morphine therapy and length of hospital stay. Dr Raith conceptualized and designed the study, provided oversight for the research procedures and data acquisition, contributed to the interpretation of the data, wrote the first draft of the article, and revised the final manuscript; Dr Schmölzer made substantial contributions to the conceptualization of the study and performed data acquisition and interpretation of data; Drs Schmölzer, Resch, Reiterer, and Avian made substantial contributions to the design of the study; Drs Raith, Resch, Reiterer, Avian, Köstenberger, and Urlesberger reviewed the manuscript and made revisions; Drs Resch and Reiterer made substantial contributions to the randomization procedures and maintained and ensured the masking of personnel; Dr Avian performed statistical analysis and interpretation of dat...

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“…Some evidence suggests a milder course of NAS in preterm neonates. 55 The rate of preterm infants did not differ between groups (P = .648).…”

Section: Discussionmentioning

confidence: 89%

Laser Acupuncture for Neonatal Abstinence Syndrome: A Randomized Controlled Trial

et al. 2015

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“…Preterm infants are reported to have a lower risk developing NAS with lower peak NAS scores than term infants. 13-14 Preterm infants have also been shown to require lower doses of opioid-replacement medications and have a shorter duration of opioid therapy than infants born at term. 10 It is hypothesized that an underdeveloped CNS, decreased hepatic clearance of methadone, and a lower cumulative in-utero opioid exposure may decrease manifestations of NAS.…”

Section: Introductionmentioning

confidence: 99%

“…10 It is hypothesized that an underdeveloped CNS, decreased hepatic clearance of methadone, and a lower cumulative in-utero opioid exposure may decrease manifestations of NAS. 10,14 …”

Section: Introductionmentioning

confidence: 99%

Comparison of Neonatal Abstinence Syndrome Manifestations in Preterm Versus Term Opioid-Exposed Infants

Allocco

Melker

Rojas-Miguez

et al. 2016

Advances in Neonatal Care

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Background Twenty to 40% of infants exposed to in-utero opioids deliver preterm. There is currently no neonatal abstinence syndrome (NAS) scoring tool known to accurately assess preterm opioid-exposed infants. This can lead to difficulties in titrating pharmacotherapy in this population. Purpose To describe NAS symptoms in preterm opioid-exposed infants in comparison with matched full-term controls. Methods This was a retrospective cohort study from a single tertiary care center of methadone-exposed infants born between 2006 - 2010. Using modified Finnegan scores recorded every 3-4 hours beginning at 6 hours of life until 24-48 hours after medication discontinuation, NAS symptomatology was compared between 45 preterm infants and 49 full-term matched controls. Concurrent neonatal medical diagnoses were also compared. Results The median gestational age in the preterm group was 35 weeks (IQR 33-36) vs 39 weeks (IQR 38-40) in the term group. Preterm infants scored less frequently for many items including sleep disturbance (24.4 vs 46.2%), tremors (77.9 vs 89.7%), muscle tone (87.9 vs 97.4%), sweating (2.1 vs 9.4%), nasal stuffiness (11.9 vs 20.5%), and loose stools (7.0 vs 14.3%) when compared with full-term controls. Preterm infants scored more frequently for hyperactive moro reflex (26.4 vs 5.5%), tachypnea (19.3 vs 16.1%), and poor feeding (24.6 vs 11.8%). Implications for Practice Provider awareness of differences in manifestations of preterm and term NAS infants, as well as concurrent prematurity diagnoses that can influence NAS scoring is needed. These findings mandate the development of a modified NAS scoring tool for the preterm NAS population. Implications for Research A preterm NAS scoring tool needs to be developed and validated to more accurately assess and treat preterm opioid-exposed infants.

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“…Returning to Figure 2, the relationship with gestational age can be envisioned by replacing heroin relapse with gestational age at birth. While data suggest that preterm infants are less likely to be treated for NAS, it remains unclear whether this is due to NAS severity or physiological immaturity [30,31] and whether opioid agonist therapy is causally related to preterm birth [7,18]. If the DAG is correct, the arguments above negating the need to adjust for a consequence of exposure also apply to gestational age at birth.…”

Section: Resultsmentioning

confidence: 99%

Confounding of the Comparative Safety of Prenatal Opioid Agonist Therapy

et al. 2015

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Prenatal opioid agonist therapy with methadone or buprenorphine prevents maternal illicit opioid use and withdrawal and improves pregnancy outcomes compared to heroin use alone. Historically, methadone has been the first-line opioid agonist therapy for pregnant opioid dependent women; in recent years buprenorphine has become first-line treatment for some opioid dependent pregnant women. While there is some evidence of better outcomes in neonates exposed to buprenorphine vs. methadone, the effect of confounding from differences in women who use buprenorphine and methadone has not been carefully examined in most studies. This review explores mechanisms by which confounding can arise in measuring associations between prenatal buprenorphine vs. methadone exposure on neonatal outcomes using a graphical approach, directed acyclic graphs. The goal of this paper is to facilitate better understanding of the factors influencing neonatal abstinence syndrome and accurate assessment of the comparative safety of opioid agonist therapies on the neonate.

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Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome

Cited by 44 publications

References 23 publications

Laser Acupuncture for Neonatal Abstinence Syndrome: A Randomized Controlled Trial

Laser Acupuncture for Neonatal Abstinence Syndrome: A Randomized Controlled Trial

Comparison of Neonatal Abstinence Syndrome Manifestations in Preterm Versus Term Opioid-Exposed Infants

Confounding of the Comparative Safety of Prenatal Opioid Agonist Therapy

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