Higher Buprenorphine Dose May Not Increase Severity of Neonatal Abstinence Syndrome

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The study included 89 mother-infant pairs maintained on buprenorphine.
The study included 89 mother-infant pairs maintained on buprenorphine.

Pregnant women receiving medication therapy for addiction can be prescribed higher doses of buprenorphine without increasing the risk or severity of neonatal abstinence syndrome (NAS), according to a study published in the Journal of Addiction Medicine.

The study included mother-infant pairs maintained on buprenorphine, with mothers who delivered at the Swedish Medical Center First Hill Campus from January 1, 2000, through April 1, 2016. Mothers had diagnosed opioid dependency and were aged 18 to 53 years. The primary outcomes were requirement of morphine treatment, peak NAS score, peak morphine dose, time to morphine start, days on morphine, and total duration of hospital stay.

Of 89 infants, 43.8% had NAS requiring morphine, with a mean 55.2 hours to morphine start, a mean of 15.9 days on morphine, and a mean of 20 days' hospital stay. NAS requiring morphine occurred in 48.5% of infants of women receiving ≤8 mg/day buprenorphine and in 41.4% of infants of women receiving >8 mg/day. No associations were established between maternal buprenorphine dose and peak NAS score, NAS severity requiring morphine, time to morphine start, peak morphine dose, or days receiving morphine.

Exclusive breastfeeding was associated with reduced odds of morphine treatment for the infant (odds ratio, 0.24; P =.003).

"Providers should feel comfortable going to higher doses of buprenorphine if needed to keep women engaged in care, minimize cravings/withdrawal, and reduce risk of relapse," the researchers wrote.

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Reference

Wong J, Saver B, Scanlan JM, et al. Does maternal buprenorphine dose affect severity or incidence of neonatal abstinence syndrome? [published June 13, 2018]. J Addict Med. doi: 10.1097/ADM.0000000000000427

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