Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome

Abstract

AIMS-Over half of infants exposed to opioids in utero develop neonatal abstinence syndrome (NAS) of severity to require pharmacologic therapy. Current treatments are associated with prolonged hospitalization. We sought to optimize the dose of sublingual buprenorphine in the treatment of NAS. DESIGN-Randomized PARTICIPANTS-Twenty-four term infants requiring pharmacological treatment for NAS.MEASUREMENTS-Outcomes were neonatal safety, length of treatment, and length of hospitalization.FINDINGS-Sublingual buprenorphine was safe and effective. Infants treated with buprenorphine had a 23-day length of treatment compared to 38 days for those treated with morphine (p=0.01), representing a 40% reduction. Length of hospital stay in the buprenorphine group was reduced 24%, from 42 to 32 days (p=0.05).CONCLUSIONS-Sublingual buprenorphine was safe in NAS, with a substantial efficacy advantage over standard of care therapy with oral morphine.

Variation in treatment of neonatal abstinence syndrome in US Children's Hospitals, 2004–2011

“…As these codes could be used by providers to describe infants exposed to opioids in utero who do not require pharmacotherapy, we further restricted our sample to include infants treated during the hospitalization with opioids (methadone, morphine and buprenorphine), 8,20,21 barbiturates (phenobarbital), 8 alpha agonist (clonidine) 22 or benzodiazepines (clonazepam, diazepam, lorazepam or midazolam) 23,24 based upon a literature review.…”

Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome

“…8,9 Buprenorphine was administered at a dose of 0.075 mg per milliliter of solution in simple syrup and 30% ethanol, which is stable for at least 7 days at room temperature. 11 Placebo for buprenorphine contained no ethanol (1.75 ml of simple syrup in 2.25 ml of sterile water).…”

Neonatal Abstinence Syndrome

“…151 Buprenorphine is a new option for the treatment of NAS and must be given sublingually; however, no large-scale studies are available to support the use of this medication. 152 Ideally, both methadone and buprenorphine are logical choices, if the mothers were receiving these medications prenatally.…”