Treatment of neonatal abstinence syndrome with clonidine and chloral hydrate

Esmaeili, Anoosh; Keinhorst, AK; Schuster, Tilman; Beske, Florian; Schlößer, Rolf; Bastanier, C

doi:10.1111/j.1651-2227.2009.01547.x

Cited by 38 publications

(24 citation statements)

References 13 publications

(16 reference statements)

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“…In a retrospective case series, infants who had evidence of NAS attributable to antenatal methadone exposure had lower severity scores and required fewer days of drug therapy and hospitalization if they had been treated with a combination of clonidine and chloral hydrate rather than a combination of morphine and phenobarbital. 135 A recently published case series from France that used a historical cohort for a comparison has suggested that the treatment of NAS with the phenothiazine, chlorpromazine, as a single drug may be more effective than treatment with morphine. 136 Infants treated with oral morphine had significantly longer median durations of treatment and hospitalization in comparison with infants treated with chlorpromazine.…”

Section: 119-121mentioning

confidence: 99%

Neonatal Drug Withdrawal

Hudak¹,

Tan²,

Frattarelli³

et al. 2012

Pediatrics

737

608

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Maternal use of certain drugs during pregnancy can result in transient neonatal signs consistent with withdrawal or acute toxicity or cause sustained signs consistent with a lasting drug effect. In addition, hospitalized infants who are treated with opioids or benzodiazepines to provide analgesia or sedation may be at risk for manifesting signs of withdrawal. This statement updates information about the clinical presentation of infants exposed to intrauterine drugs and the therapeutic options for treatment of withdrawal and is expanded to include evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.

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Section: 119-121mentioning

confidence: 99%

Neonatal Drug Withdrawal

Hudak¹,

Tan²,

Frattarelli³

et al. 2012

Pediatrics

737

608

View full text Add to dashboard Cite

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“…No largescale studies have proven the efficacy of clonidine for NAS. 153,154 Clonidine and phenobarbital levels can be monitored, and both are beneficial for decreasing the duration of treatment as well as for curtailing the use of higher doses of morphine or methadone. 138,155 …”

Section: Pharmacological Carementioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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“…25,26,45 Clonidine as adjunctive therapy for NAS was associated with a decrease in the number of morphine doses, duration of treatment, or length of hospital stay. 25,45 From a recent randomized trial, clonidine given with morphine resulted in a shorter duration of therapy compared with the morphine and phenobarbital combination.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 Recent studies found that clonidine was an effective adjunctive treatment when given with morphine or chloral hydrate. 25,26 Because of potential deleterious effects of continued postnatal opiate administration on the developing brain, 27 we evaluated the use of clonidine in the treatment of infants with NAS. We tested the hypothesis that clonidine would be better than morphine as a single-drug therapy for NAS as evidenced by improvement in neurobehavior and duration of treatment.…”

Section: What's Known On This Subjectmentioning

confidence: 99%

Morphine Versus Clonidine for Neonatal Abstinence Syndrome

Bada¹,

Sithisarn²,

Gibson

et al. 2015

Pediatrics

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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.

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Treatment of neonatal abstinence syndrome with clonidine and chloral hydrate

Abstract: This study suggests that a treatment of neonatal abstinence syndrome with clonidine in omission of opiates is possible without causing short-term adverse cardiovascular effects. Considering the retrospective design of the study, controlled and prospective trials are needed.

Cited by 38 publications

References 13 publications

Neonatal Drug Withdrawal

Neonatal Drug Withdrawal

Neonatal Abstinence Syndrome

Morphine Versus Clonidine for Neonatal Abstinence Syndrome

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