© 2004 Archives of Disease in Childhood Fetal and Neonatal Edition
ORIGINAL ARTICLE
A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome
Neonatal Unit, Princess Royal Maternity Hospital, Glasgow Royal Infirmary, Glasgow, Scotland, UK
Correspondence to:
Correspondence to:
Dr Jackson
Neonatal Unit, Princess Royal Maternity Hospital, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, Scotland, UK; LesleyJackson{at}yahoo.co.uk
Background: The incidence of neonatal abstinence syndrome (NAS) has increased 10-fold over the last decade in Glasgow. In the Princess Royal Maternity Hospital, it now accounts for 17% of special care baby unit (SCBU) admissions.
Objective: To compare opiate replacement therapy (morphine sulphate) with the present standard treatment (phenobarbitone) for management of NAS. The primary study end point was duration of pharmaceutical treatment. Secondary end points were the requirement for additional drugs and the requirement for SCBU admission.
Design: Double blind, randomised controlled clinical trial.
Methods: Differential diagnoses were excluded, and two consecutive Lipsitz scores > 4 defined NAS requiring treatment. Infants were randomised to receive morphine sulphate or phenobarbitone. Treatments were identical in appearance, odour, and volume. Increments, decrements, and discontinuation of treatments were protocol driven.
Results: Seventy five infants participated. All mothers received opiate replacement therapy (methadone) during pregnancy and most used other drugs (n = 62, 83%). No significant difference in maternal drug use patterns was observed between treatment groups. Median treatment duration was four days shorter with opiate replacement (8 v 12 days, Mann-Whitney U test, p = 0.02). Phenobarbitone treated infants tended to require second line treatment (47% v 35%, 
2 test, p = 0.11) and SCBU admission (62% v 30%, 2 test, p = 0.04) more often.
Conclusions: Opiate replacement therapy appears to be superior for management of symptomatic NAS when maternal opiate use is prevalent. The shorter treatment duration and lower requirement for higher intensity nursing may have significant cost implications. Tailoring NAS treatment to local maternal drug use may result in similar benefits.
Abbreviations: NAS, neonatal abstinence syndrome; SCBU, special care baby unit
Keywords: neonatal abstinence syndrome; opiate; phenobarbitone; randomised controlled trial
Relevant Article
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Arch. Dis. Child. Fetal Neonatal Ed. 2004 89: F283.
This article has been cited by other articles:
-
McGlone, L, Mactier, H, Weaver, L T
(2009). Drug misuse in pregnancy: losing sight of the baby?. Arch. Dis. Child.
94: 708-712
[Abstract] [Full Text] -
Cohen, R. S.
(2009). Fentanyl Transdermal Analgesia During Pregnancy and Lactation. J Hum Lact
25: 359-361
[Abstract] -
O'Grady, M J, Hopewell, J, White, M J
(2009). Management of neonatal abstinence syndrome: a national survey and review of practice. Arch. Dis. Child. Fetal Neonatal Ed.
94: F249-F252
[Abstract] [Full Text] -
Kraft, W. K., Gibson, E., Dysart, K., Damle, V. S., LaRusso, J. L., Greenspan, J. S., Moody, D. E., Kaltenbach, K., Ehrlich, M. E.
(2008). Sublingual Buprenorphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Trial. Pediatrics
122: e601-e607
[Abstract] [Full Text] -
Crocetti, M. T., Amin, D. D., Jansson, L. M.
(2007). Variability in the Evaluation and Management of Opiate-Exposed Newborns in Maryland. CLIN PEDIATR
46: 632-635
[Abstract] -
Glasser, S. P., Salas, M., Delzell, E.
(2007). Importance and Challenges of Studying Marketed Drugs: What Is a Phase IV Study? Common Clinical Research Designs, Registries, and Self-Reporting Systems. J Clin Pharmacol
47: 1074-1086
[Abstract] [Full Text]
eLetters:
Read all eLetters
- Randomised controlled trial of morphine vs. phenobarbitone for NAS: which treatment is better?
- KAPIL GARGH, et al.
- Fetal Neonatal Ed. Online, 20 Apr 2005 [Full text]
- Full Text
- Full Text (PDF)
- Submit a response
- Read responses to this article
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in ADC Online
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
