Abstract
Objective:
Each year in the US ∼50 000 neonates receive inpatient pharmacotherapy for the treatment of neonatal abstinence syndrome (NAS). The objective of this study is to compare the safety and efficacy of a traditional inpatient only approach with a combined inpatient and outpatient methadone treatment program.
Study Design:
Retrospective review (2007 to 2009). Infants were born to mothers maintained on methadone in an antenatal substance abuse program. All infants received methadone for NAS treatment as inpatient. Methadone weaning for the traditional group (75 patients) was inpatient, whereas the combined group (46 patients) was outpatient.
Result:
Infants in the traditional and combined groups were similar in demographics, obstetrical risk factors, birth weight, gestational age (GA) and the incidence of prematurity (34 and 31%). Hospital stay was shorter in the combined than in the traditional group (13 vs 25 days; P<0.01). Although the duration of treatment was longer for infants in the combined group (37 vs 21days, P<0.01), the cumulative methadone dose was similar (3.6 vs 3.1 mg kg−1, P=0.42). Follow-up information (at least 3 months) was available for 80% of infants in the traditional and 100% of infants in the combined group. All infants in the combined group were seen ⩽72 h from hospital discharge. Breastfeeding was more common among infants in the combined group (24 vs 8% P<0.05). Following discharge there were no differences between the two groups in hospital readmissions for NAS. Prematurity (34 to 36 weeks GA) was the only predictor for hospital readmission for NAS in both groups (P=0.02, OR 5). Average hospital cost for each infant in the combined group was $13 817 less than in the traditional group.
Conclusion:
A combined inpatient and outpatient methadone treatment in the management of NAS decreases hospital stay and substantially reduces cost. Additional studies are needed to evaluate the potential long-term benefits of the combined approach on infants and their families.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Kuschel C . Managing drug withdrawal in the newborn infant. Semin Fetal Neonatal Med 2007; 12: 127–133.
Jones H, Kaltenbach K, Heil SH, Stine SM, Coyle MG, Arria AM et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med 2010; 363: 2320–2331.
Finnegan LP, Connaughton Jr JF, Kron RE, Emich JP . Neonatal abstinence syndrome: assessment and management. Addict Dis 1975; 2: 141–158.
Kellogg A, Rose CH, Harms RH, Watson WJ . Current trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstet Gynecol 2011; 204: 259.e104.
American academy of pediatrics (AAP) committee on drugs. Neonatal drug withdrawal. Pediatrics 1998; 101: 1079–1088.
Ebner N, Rohrmeister K, Winklbaur B, Baewert A, Jagsch R, Peternell A et al. Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Drug Alcohol Depend 2007; 87: 131–138.
Dryden C, Young D, Hepburn M, Mactier H . Maternal methadone use in pregnancy: factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources. BJOG 2009; 116: 665–671.
Svikis CS, Golden AS, Huggins GR, Pickens RW, McCaul ME, Velez ML et al. Cost-effectiveness of treatment for drug-abusing pregnant women. Drug Alcohol Depend 1997; 45: 105–113.
Hulse GK, Milne E, English DR, Holman CDJ . Assessing the relationship between maternal opiate use and neonatal mortality. Addiction 1998; 93: 1033–1042.
Arlettaz R, Kashiwagi M, Das-Kundu S, Fauchere J, Lang A, Bucher HU . Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources. Acta Obstet Gynecol Scand 2005; 84: 145–150.
Burns L, Mattick RP, Lim K, Wallace C . Methadone in pregnancy: treament retention and neonatal outcomes. Addiction 2007; 102: 264–270.
Mattick RP, Breen C, Kimber J, Davoli M . Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev 2009; 3: CD002209.
Johnson K, Gerada C, Greenough A . Substance misuse during pregnancy. Brit J Psych 2003; 183: 187–189.
Hunt RW, Tzioumi D, Collins E, Jeffery HE . Adverse neurodevelopmental outcome of infants exposed to opiate in-utero. Early Hum Dev 2008; 84: 29–35.
McCarthy JJ, Leamon MH, Parr MS, Anania B . High dose methadone maintenance in pregnancy: maternal and neonatal outcomes. Am J Obstet Gynecol 2005; 193: 606–610.
Lainwala S, Brown ER, Weinschenk NP, Blackwell MT, Hagadorn JI . A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care 2005; 5: 265–272.
Langenfeld S, Birkenfeld L, Herkenrath P, Müller C, Hellmich M, Theisohn M . Therapy of the neonatal abstinence syndrome with tincture of opium or morphine drops. Drug Alcohol Depend 2005; 77: 31–36.
Isemann B, Meinzen-Derr J, Akinibi H . Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol 2011; 31: 25–29.
O’Grady MJ, Hopewell J, White MJ . Management of neonatal abstinence syndrome: a national survey and review of practice. Arch Dis Child Fetal Neonatal Ed 2009; 94: F249–F252.
Abrahams RR, Kelly SA, Payne S, Thiessen PN, Mackintosh J, Janssen PA . Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Can Fam Physician 2007; 53: 1722–1730.
Velez M, Jansson LM . The opioid dependent mother and newborn dyad: non-pharmacologic care. J Addict Med 2008; 2: 113–120.
Saiki T, Lee S, Hannam S, Greenough A . Neonatal abstinence syndrome—postnatal ward versus neonatal unit management. Eur J Pediatr 2010; 169: 95–98.
Oei J, Feller JM, Lui K . Coordinated outpatient care of the narcotic-dependent infant. J Paediatr Child Health 2001; 37: 266–270.
Jansson LM, Velez M, Harrow C . The opioid exposed newborn: assessment and pharmacologic management. J Opioid Manag 2009; 5: 47–55.
Chasnoff I, Burns W . The moro reaction: a scoring system for neonatal narcotic withdrawal. Dev Med Child Neurol 1984; 26: 484–486.
Chasnoff IJ . Newborn infants with drug withdrawal smptoms. Pediatr Rev 1988; 9: 273–277.
Kwan P, Brodie MJ . Phenobarbital for the treatment of epilepsy in the 21st century: a critical review. Epilepsia 2004; 45: 1141–1149.
Soepatmi S . Developmental outcomes of children of mothers dependent on heroin or heroin/methadone during pregnancy. Acta Paediatr Suppl 1994; 404: 36–39.
Selleck CS, Redding BA . Knowledge and attitudes of registered nurses toward perinatal substance abuse. JOGNN 1988; 27: 70–77.
Serane VT, Kurian O . Neonatal abstinence syndrome. Indian J Pediatr 2008; 75: 911–914.
Doberczak TM, Kandall SR, Wilets I . Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr 1991; 118: 933–937.
American Academy of Pediatrics. Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108: 776–789.
Abdel-Latif ME, Pinner J, Clews S, Cook F, Lui K, Oei J . Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2005; 117: e1163–e1169.
Jansson LM, Choo R, Velez ML, Harrow C, Schroeder JR, Shakleya DM et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 2008; 121: 106–114.
Jackson L, Ting A, Mckay S, Galea P, Skeoch C . A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed 2004; 39: F300–F304.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Backes, C., Backes, C., Gardner, D. et al. Neonatal abstinence syndrome: transitioning methadone-treated infants from an inpatient to an outpatient setting. J Perinatol 32, 425–430 (2012). https://doi.org/10.1038/jp.2011.114
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2011.114
Keywords
This article is cited by
-
Supporting breastfeeding for women on opioid maintenance therapy: a systematic review
Journal of Perinatology (2019)
-
Prenatal treatment for opioid dependency: observations from a large inner-city clinic
Addiction Science & Clinical Practice (2017)
-
A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic
Journal of Perinatology (2017)
-
Oral Morphine Weaning for Neonatal Abstinence Syndrome at Home Compared with In-Hospital: An Observational Cohort Study
Pediatric Drugs (2015)