Does Maternal Buprenorphine Dose Affect Severity or Incidence of Neonatal Abstinence Syndrome?

https://journals.lww.com/journaladdictionmedicine/Abstract/2018/12000/Does_Maternal_Buprenorphine_Dose_Affect_Severity.5.aspx?fbclid=IwAR1wrQd8Z9wztT3bHlBfjplZPtpuEJ87wm9NeTMjkbvFey_kJTZ7Xc_JtOg

Comments; Local to me, Methadone is still the drug of choice for NAS.  We need to see how these infants do with BUP when Mom was maintained on it during gestation.

Wong, Jacqueline, MD; Saver, Barry, MD, MPH; Scanlan, James M., PhD;  Gianutsos, Louis Paul, MD, MPH; Bhakta, Yachana, BS; Walsh, James, MD; Plawman, Abigail, MD; Sapienza, David, MD; Rudolf, Vania, MD,MPH Journalof Addiction Medicine: November/December2018 – Volume 12 – Issue 6 – p 435–441

doi: 10.1097/ADM.0000000000000427

Abstract

Objectives: To measure the incidence, onset, duration, and severity of neonatal abstinence syndrome (NAS) in infants born to mothers receiving buprenorphine and to assess the association between buprenorphine dose and NAS outcomes.

Methods: We reviewed charts of all mother–infant pairs maintained on buprenorphine who delivered in our hospital from January 1, 2000 to April 1, 2016.

Results: In 89 infants, NAS incidence requiring morphine was 43.8%. Means for morphine-treated infants included: 55.2 hours to morphine start, 15.9 days on morphine, and 20 days hospital stay. NAS requiring morphine treatment occurred in 48.5% and 41.4% of infants of mothers receiving ≤8 mg/d buprenorphine versus>8 mg/d, respectively (P =0.39). We found no significant associations of maternal buprenorphine dose with peak NAS score, NAS severity requiring morphine, time to morphine start,peak morphine dose, or days on morphine. Among the other factors examined, only exclusive breastfeeding was significantly associated with neonatal outcomes, specifically lower odds of morphine treatment (odds ratio 0.24, P = 0.003).

Conclusions: These findings suggest higher buprenorphine doses can be prescribed to pregnant women receiving medication therapy for addiction without increasing NAS severity. Our finding of reduced risk of NAS requiring morphine treatment also suggests breastfeeding is both safe and beneficial for these infants and should be encouraged.© 2018 American Society of Addiction Medicine