Management of neonatal abstinence syndrome in neonates born to opioid maintained women

Neonates born to opioid-maintained mothers are at risk of developing neonatal abstinence syndrome (NAS), which often requires pharmacological treatment. This study examined the effect of opioid maintenance treatment on the incidence and timing of NAS, and compared two different NAS treatments (phenobarbital versus morphine hydrochloride).Fifty-three neonates born to opioid-maintained mothers were included in this study. The mothers received methadone (n = 22), slow-release oral morphine (n = 17) or buprenorphine (n = 14) throughout pregnancy. Irrespective of maintenance treatment, all neonates showed APGAR scores comparable to infants of non-opioid dependent mothers. No difference was found between the three maintenance groups regarding neonatal weight, length or head circumference. Sixty percent (n = 32) of neonates required treatment for NAS [68% in the methadone-maintained group (n = 15), 82% in the morphine-maintained group (n = 14), and 21% in the buprenorphine-maintained group (n = 3)]. The mean duration from birth to requirement of NAS treatment was 33 h for the morphine-maintained group, 34 h for the buprenorphine-maintained group and 58 h for the methadone-maintained group.In neonates requiring NAS treatment, those receiving morphine required a significantly shorter mean duration of treatment (9.9 days) versus those treated with phenobarbital (17.7 days). Results suggest that morphine hydrochloride is preferable for neonates suffering NAS due to opioid withdrawal.