Methadone Improves Short-Term Outcomes Better Than Morphine in Neonatal Abstinence Syndrome

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Term infants with neonatal abstinence syndrome were randomly assigned to receive methadone or morphine.
Term infants with neonatal abstinence syndrome were randomly assigned to receive methadone or morphine.

Methadone may be superior to morphine for reducing hospital length of stay and length of drug treatment in infants with neonatal abstinence syndrome, according to a study published in JAMA Pediatrics.

Term infants with neonatal abstinence syndrome (n=117) from mothers who received buprenorphine, methadone, or opioids during pregnancy were randomly assigned to receive methadone (n=58) or morphine (n=58). Treatment (methadone, morphine, or placebo) was administered every 4 hours, at which point, infants were assessed with the Finnegan Neonatal Abstinence Scoring System.

Infants with Finnegan scores that remained consistently elevated were given increased doses of medication. Phenobarbital was given to infants who exceeded a predetermined opioid dose. Hospital length of stay was the primary end point, and secondary end points included hospital length of stay resulting from neonatal abstinence syndrome and length of drug treatment.

Infants receiving methadone had a 14% greater decrease in the length of hospital stay (relative number of days, 0.86; 95% CI, 0.74-1.00; P =.046). This reduction translated to an overall difference of 2.9 days. In addition, there was a 14% reduction in hospital length of stay that was primarily attributable to neonatal abstinence syndrome (relative number of days, 0.86; 95% CI, 0.77-0.96; P =.01), translating to a 2.7-day difference. A 16% reduction in length of drug treatment was found to be associated with methadone treatment (relative number of days, 0.84; 95% CI, 0.73-0.97; P =.02), a reduction which corresponded to a 2.3-day difference between the 2 groups.

The use of methadone vs morphine in infants with neonatal abstinence syndrome also correlated with a reduction in the median length of hospital stay (16 vs 20 days, respectively; P =.005), methadone vs attributable to neonatal abstinence syndrome (16 vs 19 days, respectively; P =.005), and length of drug treatment (11.5 vs 15 days, P =.009).

The small population sample represents the study's primary limitation.

“A more complete understanding of the factors that determine the severity of [neonatal abstinence syndrome] and the long-term safety of different treatment approaches…will help refine best practices and reduce the societal and financial burden of [neonatal abstinence syndrome] while improving short- and longer-term outcomes in this highly vulnerable population,” concluded the study authors.

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Reference

Davis JM, Shenberger J, Terrin N, et al. Comparison of safety and efficacy of methadone vs morphine for treatment of neonatal abstinence syndrome: a randomized clinical trial [published online June 18, 2018]. JAMA Pediatr. doi: 10.1001/jamapediatrics.2018.1307

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