Neonatal neurobehavior effects following buprenorphine versus methadone exposure

Mara G. Coyle, Amy L. Salisbury, Barry M. Lester, Hendrée E. Jones, Hai Lin, Klaudia Graf-Rohrmeister, Gabriele Fischer

Research output: Contribution to journalArticlepeer-review


Aim: To determine the effects of in utero exposure to methadone or buprenorphine on infant neurobehavior. Design: Three sites from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, a double-blind, double-dummy, randomized clinical trial participated in this substudy. Setting: Medical Centers that provided comprehensive maternal care to opioid-dependent pregnant women in Baltimore, MD, Providence, RI and Vienna, Austria. Participants: Thirty-nine full-term infants. Measurements: The Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale (NNNS) was administered to a subgroup of infants on postpartum days 3, 5, 7, 10, 14-15 and 28-30. Findings: While neurobehavior improved for both medication conditions over time, infants exposed in utero to buprenorphine exhibited fewer stress-abstinence signs (P<0.001), were less excitable (P<0.001) and less over-aroused (P<0.01), exhibited less hypertonia (P<0.007), had better self-regulation (P<0.04) and required less handling (P<0.001) to maintain a quiet alert state relative to in utero methadone-exposed infants. Infants who were older when they began morphine treatment for withdrawal had higher self-regulation scores (P<0.01), and demonstrated the least amount of excitability (P<0.02) and hypertonia (P<0.02) on average. Quality of movement was correlated negatively with peak NAS score (P<0.01), number of days treated with morphine for NAS (P<0.01) and total amount of morphine received (P<0.03). Excitability scores were related positively to total morphine dose (P<0.03). Conclusion: While neurobehavior improves during the first month of postnatal life for in utero agonist medication-exposed neonates, buprenorphine exposure results in superior neurobehavioral scores and less severe withdrawal than does methadone exposure.

Original languageEnglish (US)
Pages (from-to)63-73
Number of pages11
Issue numberSUPPL.1
StatePublished - Nov 2012


  • Full-term infant
  • NICU Network Neurobehavioral Scale (NNNS)
  • Neonatal abstinence syndrome
  • Neurobehavior
  • Opioid exposed newborn

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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