Buprenorphine Is Superior to Morphine for the Treatment of Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) due to in utero exposure to opioids may result in autonomic instability, tremor, irritability, poor feeding, and loose stools. Two-thirds of infants born with this condition do not respond to conservative measures including minimizing stimulation, in-rooming, breastfeeding, and frequent calorically dense feeds and therefore may require tapering doses of opioid medication to manage symptoms. If medication is required, typically morphine is administered in 80% of cases of NAS due to opioids and is often associated with increased length of stay and resource utilization. The authors of this single site, double blind, double dummy trial randomly assigned 63 (of the planned 80) term infants (≥37 weeks gestation) to buprenorphine or morphine for the treatment of NAS with the primary endpoint of treatment duration. Infants born to mothers receiving buprenorphine or methadone during pregnancy were included.

• Using an intent-to-treat analysis, the median duration of NAS treatment was significantly shorter with buprenorphine than with morphine (15 days versus 28 days).
• Median length of hospital stay was shorter in the buprenorphine group (21 days versus 33 days). Adjunctive phenobarbital was administered in 5 of 33 infants (15%) in the buprenorphine group and in 7 of 30 infants (23%) in the morphine group. Overall, 13 adverse events occurred; 2 were considered serious. There were no differences between the 2 groups with regard to adverse events.

Comments: Despite the small sample size and the single site design, the results of this study suggest that buprenorphine is superior to morphine for the treatment of NAS due to opioid exposure, in terms of treatment duration and length of stay. The results of this study cannot be generalized to preterm infants and those exposed to benzodiazepines in utero as these were important exclusion criteria.

Jeanette M. Tetrault, MD

Reference: Kraft WK, Adeniyi-Jones SC, Chervoneva I, et al. Buprenorphine for the treatment of the neonatal abstinence syndrome. N Engl J Med. 2017;376(24):2341–2348.