Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome

Abstract

Objective: To identify maternal and neonatal factors that impact response to methadone therapy for neonatal abstinence syndrome.Study Design: This is a retrospective review of 128 infants that received pharmacotherapy for opiate withdrawal to identify factors associated with favorable response to methadone therapy. Maternal and neonatal data were analyzed with univariate statistics and multivariate logistic regression.Result: Maternal methadone maintenance dose during pregnancy correlated with length of stay (P ¼ 0.009). There was an inverse correlation between the amount of mother's breast milk ingested and length of stay (b ¼ À0.03, P ¼ 0.02). Methadone was initiated later, tapered more rapidly and was more successful as monotherapy in preterm infants. Five percent of infants were admitted to hospital again for rebound withdrawal following reduction of breast milk intake. Conclusion:Severity of neonatal abstinence syndrome may be mitigated by titrating methadone to the lowest effective dose during pregnancy and by encouraging breast milk feeds, which should be weaned gradually.

Neonatal Abstinence Syndrome

“…127,163 The amount of methadone or buprenorphine in breast milk is too small to treat NAS, and the sudden discontinuation of breast milk is not associated with the worsening of NAS 164,165 ; however, gradual weaning from breastfeeding is advised. 166 Because of the high concentrations of hydrocodone and oxycodone in breast milk as well as the reduced clearance of some of these medications in some neonates, mothers taking these prescription opioids should be alerted to the problem of sedation among infants when breastfeeding. [167][168][169] Breastfeeding increases mother-infant bonding, enhances maternal confidence, and encourages active maternal participation in the management of the infant.…”

Neonatal Drug Withdrawal

“…Breastfeeding or the feeding of human milk has been associated with less severe NAS that presents later and less frequently requires pharmacologic intervention. 107,108 Methadone is present in very low concentrations in human milk. Cumulative daily intake of methadone in fully breastfed infants has been estimated to range from 0.01 to 0.15 mg/day in the first 30 days of life 109 and 0.15 to 0.30 mg/day between 30 and 180 days of age.…”

A Multicenter Cohort Study of Treatments and Hospital Outcomes in Neonatal Abstinence Syndrome

“…4 In addition to the type and extent of drug exposure, 6,7 withdrawal severity and duration are affected by many factors, including tobacco use during pregnancy 8 and breastfeeding after delivery. 9,10 Among the 3.39 per 1000 infants treated for NAS in the United States annually, average length of hospitalization is ∼16 days, but prolonged stays are common. 2,11,12 NAS is becoming more prevalent in the United States.…”