HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2015, 17, 2-3 (pages: 35 - 44)

Neonatal abstinence syndrome after intrauterine opioid exposure: Standards, cost-effectiveness of treatment and maternal rights

Brandt L., Fischberger S., Unger A., Jagsch R., Moser L., and Fischer G.

Summary: Background: Multiple studies have confirmed the superiority of opioid maintenance therapy (OMT) during pregnancy, with buprenorphine giving better results than methadone in limiting neonatal abstinence syndrome (NAS) severity and treatment length. While the presence of the mother, in addition to pharmacological treatment, has a proven alleviating effect on neonates' withdrawal symptoms, joint admission perinatally is hardly possible in most countries. Methods: A prospective, standardized, observational study design was used to assess the effects of OMT on maternal and neonatal outcomes, together with NAS duration and severity, including supervised urinalysis. Sixty-eight mothers [of whom 39 were maintained on methadone (mean daily dose at delivery: 58.62 mg); 29 on buprenorphine (9.60 mg)] in multidisciplinary treatment, and their neonates were analysed. NAS was assessed by applying a modified Finnegan scale, and was treated with morphine solution. Results: For both groups mean gestational age at delivery was 39 weeks, with a mean birth weight of 2,967 g. Exposure to buprenorphine, when compared with exposure to methadone, yielded a significantly lower neonatal morphine dose (mean total dose 8.65 mg vs. 22.80 mg, p=0.008) and NAS treatment length (12.38 vs. 18.86 days, p=0.040), with no correlation between mean OMT dose and NAS severity. However, no significant difference in neonatal hospital stay occurred (19.23 vs. 23.43 days; p=0.241); intrauterine buprenorphine-exposed neonates were hospitalized for an average of seven additional days after the completion of NAS treatment. Conclusions: By now high quality standards of care for OMT during pregnancy have been successfully established; even so, considerable improvements in postnatal care are still required, partly to reduce the heavy economic burden due to prolonged hospitalization.