Differences in the profile of neonatal abstinence syndrome signs in methadone- versus buprenorphine-exposed neonates

Diann E. Gaalema, Teresa Linares Scott, Sarah H. Heil, Mara G. Coyle, Karol Kaltenbach, Gary J. Badger, Amelia M. Arria, Susan M. Stine, Peter R. Martin, Hendrée E. Jones

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: To compare the profile of signs of neonatal abstinence syndrome (NAS) in methadone- versus buprenorphine-exposed infants. Design, setting and participants: Secondary analysis of NAS data from a multi-site, double-blind, double-dummy, flexible-dosing, randomized clinical trial. Data from a total of 129 neonates born to opioid-dependent women who had been assigned to receive methadone or buprenorphine treatment during pregnancy were examined. Measurements: For 10 days after delivery, neonates (methadone=72, buprenorphine=57) were assessed regularly using a 19-item modified Finnegan scale. Data from neonates who required pharmacological treatment (methadone=41, buprenorphine=27) were included up to the time treatment was initiated. The incidence and mean severity of the total NAS score and each individual sign of NAS were calculated and compared between medication conditions, as was the median time until morphine treatment initiation among treated infants in each condition. Findings: Two NAS signs (undisturbed tremors and hyperactive Moro reflex) were observed significantly more frequently in methadone-exposed neonates and three (nasal stuffiness, sneezing, loose stools) were observed more frequently in buprenorphine-exposed neonates. Mean severity scores on the total NAS score and five individual signs (disturbed and undisturbed tremors, hyperactive Moro reflex, excessive irritability, failure to thrive) were significantly higher among methadone-exposed neonates, while sneezing was higher among buprenorphine-exposed neonates. Among treated neonates, methadone-exposed infants required treatment significantly earlier than buprenorphine-exposed infants (36 versus 59 hours postnatal, respectively). Conclusions: The profile of neonatal abstinence syndrome differs in methadone- versus buprenorphine-exposed neonates, with significant differences in incidence, severity and treatment initiation time. Overall, methadone-exposed neonates have a more severe neonatal abstinence syndrome.

Original languageEnglish (US)
Pages (from-to)53-62
Number of pages10
JournalAddiction
Volume107
Issue numberSUPPL.1
DOIs
StatePublished - Nov 2012

Keywords

  • Buprenorphine
  • In utero
  • Incidence
  • Methadone
  • Neonatal abstinence syndrome
  • Profile
  • Severity
  • Signs
  • Treatment initiation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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