Weaning Newborns With a Plan

Neonatal abstinence syndrome weaning worked faster following a protocol

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) When babies are born to mothers who used opiates, they may experience symptoms of withdrawal which require treatment.

A recent study found that following a specific protocol for this treatment worked better than not following an established plan.

The treatment is to give a newborn methadone or morphine and then gradually wean them off the drug.

Doing so while following an established protocol can almost cut in half the time it takes for the baby to be weaned.

"Avoid using opioids during pregnancy."

The study, led by Eric Hall, PhD, of the Perinatal Institute at Cincinnati Children’s Hospital in Ohio, investigated treatment options for newborns exposed to opioids during pregnancy.

Newborns whose mothers used opioids during pregnancy are at risk for neonatal abstinence syndrome.

Opioids include certain medications, such as codeine, hydrocodone, oxycodone, morphine or methadone, or illegal drugs, such as heroin.

This condition is basically a newborn's withdrawal effects from no longer receiving the drug. About 55 to 94 percent of babies exposed to opioids before birth experience some symptoms.

A variety of strategies exist for treating neonatal abstinence syndrome, but they are not necessarily standardized everywhere.

The researchers tracked 547 infants who had been treated with opioids after birth so that they could be weaned off.

Of these, 417 newborns were treated according to established weaning procedures, and the other 130 were treated by practitioners not necessarily followed a precise protocol.

The researchers compared how long it took for the babies in both these groups to be weaned off the opioids.

After taking into account differences in hospitals and the opioids used, the babies who were weaned with an established protocol recovered twice as quickly as those weaned without an established protocol.

It took an average 18 days for babies to be fully weaned when a treatment protocol was used, compared to 32 days for babies treated without an established weaning protocol.

Further, babies treated with a protocol-based weaning remained in the hospital an average 23 days, compared to 32 days for those treated without a protocol.

Then the researchers compared all the babies who were treated according to a protocol-based weaning to see if using methadone or morphine made a difference.

The drug used did not make a difference in terms of weaning time or length of stay in the hospital for these two treatments if used with a protocol-based weaning.

However, babies receiving phenobarbital were treated with it for a longer time period if they were receiving morphine than if they were receiving methadone.

"Use of a stringent protocol to treat neonatal abstinence syndrome, regardless of the initial opioid chosen, reduces the duration of opioid exposure and length of hospital stay," the researchers wrote.

"Because the major driver of cost is length of hospitalization, the implications for a reduction in cost of care for neonatal abstinence syndrome management could be substantial," they wrote.

But it's important to be careful in making such statements about cost, warns Adam Powell, PhD, a health economist and President of Payer+Provider Syndicate.

"The authors did not examine costs directly, and the amount of resource utilization that occurs on each hospital day is not equal," Dr. Powell said. "While a flurry of activity occurs around admission and discharge, other days can be less resource intensive, so cost often does not increase linearly with length of stay."

However, Dr. Powell said, "all else being equal, a shorter hospital stay consumes fewer hospital resources than a longer stay. In subsequent work, it may be useful for researchers to conduct a claims analysis to validate that a savings truly exists."

The study was published July 28 in the journal Pediatrics. The research was funded by the Ohio Office of Health Transformation. The authors reported no conflicts of interest.

Review Date: 
July 27, 2014
Last Updated:
July 28, 2014