"Overall, what this calls for is standardizing how we care for these infants," says Stephen Patrick, "making sure we are giving the same treatment using the best possible evidence that we can to improve outcomes for our babies and families." (Credit: Heather Katsoulis/Flickr)

Methadone best for babies born with drug withdrawal

In the United States, one infant is born each hour with drug withdrawal, but the medical care they receive varies widely, new research shows.

These infants, born with neonatal abstinence syndrome (NAS), after being exposed to opioid medications like oxycodone in utero, can have seizures, difficulty feeding, respiratory complications, and low birth weights.

A new study shows that infants treated with methadone have a shorter length of treatment and length of stay when compared to other treatment methods for infants with the condition.

For the study, published in the Journal of Perinatology, researchers looked at data from 1,424 infants with NAS at 14 major children’s hospitals and found significant variations in treatment.

“We found that, even among large children’s hospitals, only a couple of hospitals followed the same method of treatment more than 80 percent of the time,” says Stephen Patrick an assistant professor of pediatrics at Vanderbilt University, who completed the work as a neonatology fellow at the University of Michigan.

More babies born with NAS

“I think, overall, what this calls for is standardizing how we care for these infants as the American Academy of Pediatrics and World Health Organization suggests: making sure we are giving the same treatment using the best possible evidence that we can to improve outcomes for our babies and families.”

Recently, there has been a rapid increase in the number of infants born with NAS in the United States. Tennessee has been particularly affected. In some areas of the state, infants born with NAS make up 5 percent of all births, Patrick says.

“Throughout the United States we have seen a fourfold increase in sales of opioid pain relievers and, from that, we have seen complications in women and pregnant women that include anything from overdose deaths to treatment facility admissions to neonatal abstinence syndrome,” Patrick says. “I think the recent rise that we have seen in Tennessee can be attributed to the increase in sales and use of opioid pain relievers.”

Standardize care

The study looked at a combination of hospital administration and pharmacy data to evaluate differences in drug treatment for infants with NAS. Six hospitals primarily used methadone, six prescribed morphine, and two used phenobarbital. Methadone showed the best outcome.

Though more research is needed, Patrick says it is likely that methadone-treated infants will have fewer instances where they show signs of withdrawal.

Fewer signs of withdrawal could decrease the need for opioid dose escalations, potentially shortening their length of treatment and hospital stay.

“The problem with neonatal abstinence syndrome is there is not a lot of research to inform what we do. We hope to add to the evidence by comparing medications and by showing how variable care is for this vulnerable population. I hope our work will serve as a call to hospitals caring for infants with NAS to standardize how they care for patients,” Patrick says.

The Robert Wood Johnson Foundation Clinical Scholars Program, a collaboration among the Children’s Hospital of Philadelphia, Cincinnati Children’s Hospital, and the University of Michigan Health System, supported the study.

Source: Vanderbilt University

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  1. Herman Joseph

    The Mother’s study from Temple University shows that buprenorphine maintained mothers have babies with fewer withdrawal symptoms and shorter days in hospital following birth. Please comment. your study is extremely important and if valid methadone should be the preferential treatment for newborns addicted to opioids in utero–I believe buprenorphine is being used at the present time as a superior choice for treating the neo natal abstinence syndrome

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