From the Guidelines
The current treatment recommendations for neonatal iatrogenic opioid withdrawal prioritize a stepwise approach, starting with non-pharmacological interventions, followed by pharmacological treatment with an opioid as the first-line agent, as supported by the American Academy of Pediatrics 1.
Key Considerations
When implementing non-pharmacological interventions, the focus should be on minimizing environmental stimuli, swaddling, frequent small feedings, skin-to-skin contact, and rooming-in with parents.
Pharmacological Treatment
Morphine is recommended as the first-line pharmacological treatment, starting at 0.3–1.0 mg/kg per day orally divided every 3–4 hours, with the option to use methadone or buprenorphine as alternative primary agents 1. The choice of opioid and dosing should be tailored to the individual infant's symptoms and response to treatment.
Adjunctive Therapy
For infants not responding to opioid monotherapy, adjunctive therapy with clonidine or phenobarbital may be considered, with clonidine used as a secondary agent at a dose of 1 mcg/kg orally every 4 hours 1.
Weaning and Monitoring
Once the infant is stabilized, medication should be weaned gradually, typically reducing the dose by 10% per day, with close monitoring for withdrawal symptoms and adjustment of the weaning schedule as needed 1.
Treatment Duration and Follow-up
Treatment duration typically ranges from 1-4 weeks depending on severity, with close outpatient follow-up recommended after discharge to ensure ongoing support and monitoring for potential complications 1.
From the FDA Drug Label
Prolonged use of morphine sulfate tablets during pregnancy can result in withdrawal in the neonate. Neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts Use of buprenorphine hydrochloride for an extended period of time during pregnancy can result in withdrawal in the neonate. Neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts If opioid use is required for an extended period of time in a pregnant woman, advise the patient of the risk of NOWS, which may be life-threatening if not recognized and treated. Ensure that management by neonatology experts will be available at delivery
The current treatment recommendations for neonatal iatrogenic opioid withdrawal are not explicitly stated in the provided drug labels. However, it is mentioned that neonatal opioid withdrawal syndrome requires management according to protocols developed by neonatology experts 2, 3, 3.
- Key points:
- Neonatal opioid withdrawal syndrome can be life-threatening if not recognized and treated.
- Management should be according to protocols developed by neonatology experts.
- Pregnant women using opioids for an extended period should be advised of the risk of neonatal opioid withdrawal syndrome. It is essential to follow the guidelines and protocols set by neonatology experts to ensure proper management of neonatal opioid withdrawal syndrome.
From the Research
Current Treatment Recommendations for Neonatal Iatrogenic Opioid Withdrawal
- The current treatment recommendations for neonatal iatrogenic opioid withdrawal involve a combination of non-pharmacological therapies and pharmacological options 4, 5, 6.
- Pharmacological treatment with opioids such as morphine or methadone may be used to manage neonatal opioid withdrawal syndrome (NOWS) 4, 7.
- Buprenorphine has emerged as a potential treatment option for NOWS due to its pharmacologic profile and results from initial single-site clinical trials 6.
- The choice of pharmacological treatment may depend on various factors, including the type and dose of opioid exposure, the severity of withdrawal symptoms, and the presence of any underlying medical conditions 4, 7.
Comparison of Treatment Options
- A study comparing morphine and methadone for the treatment of NOWS found no significant difference in hospital length of stay or length of treatment between the two groups 7.
- Another study found that morphine may increase days of hospitalization and treatment compared to supportive care alone, but may reduce days to regain birthweight and the duration of supportive care each day 4.
- Buprenorphine may reduce duration of hospitalization and treatment compared to morphine, but more research is needed to determine its safety and effectiveness 4, 6.
Assessment and Management of Iatrogenic Neonatal Abstinence Syndrome
- Assessment of iatrogenic neonatal abstinence syndrome involves clinical evaluation of symptoms and the use of clinical assessment tools to determine the need for pharmacotherapy 5, 8.
- Prevention and management of iatrogenic neonatal abstinence syndrome in the NICU require a comprehensive approach, including careful monitoring of opioid exposure and withdrawal symptoms, and timely intervention with non-pharmacological and pharmacological therapies as needed 8.