TY - JOUR
T1 - Phenobarbital and clonidine as secondary medications for neonatal opioid withdrawal syndrome
AU - the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and the NIH Environmental Influences on Child Health Outcomes (ECHO) Program Institutional Development Awards States Pediatric Clinical Trials Ne
AU - Merhar, Stephanie L.
AU - Ounpraseuth, Songthip
AU - Devlin, Lori A.
AU - Poindexter, Brenda B.
AU - Young, Leslie W.
AU - Berkey, Sean D.
AU - Crowley, Moira
AU - Czynski, Adam J.
AU - Kiefer, Autumn S.
AU - Whalen, Bonny L.
AU - Das, Abhik
AU - Fuller, Janell F.
AU - Higgins, Rosemary D.
AU - Thombre, Vaishali
AU - Lester, Barry M.
AU - Smith, P. Brian
AU - Newman, Sarah
AU - Sánchez, Pablo J.
AU - Smith, M. Cody
AU - Simon, Alan E.
AU - Joseph, Jill G.
AU - Polin, Richard A.
AU - Singleton, Rosalyn
AU - Hirschfeld, Matthew
AU - Shaw, Jennifer
AU - Swango-Wilson, Amy
AU - Herrick, Mary
AU - Hallas, Christine
AU - Laptook, Abbot
AU - Keszler, Martin
AU - Chun, Thomas
AU - Dennery, Phyllis
AU - Hensman, Angelita M.
AU - Trailburns, Elizabeth
AU - Snowden, Jessica
AU - Nesmith, Clare
AU - Courtney, Sherry
AU - Barr, Frederick
AU - James, Laura
AU - Pearson, Denise
AU - McConnell, Jana
AU - Mason, Melanie
AU - Walsh, Michele
AU - Hibbs, Anna Marie
AU - Newman, Nancy S.
AU - Clarke, Leslie
AU - Grisby, Cathy
AU - Beiersdorfer, Traci
AU - Ross, Judith
AU - Kowal, Karen
N1 - Publisher Copyright:
Copyright © 2021 by the American Academy of Pediatrics
PY - 2021/3/1
Y1 - 2021/3/1
N2 - BACKGROUND AND OBJECTIVES: Despite the neonatal opioid withdrawal syndrome (NOWS) epidemic in the United States, evidence is limited for pharmacologic management when first-line opioid medications fail to control symptoms. The objective with this study was to evaluate outcomes of infants receiving secondary therapy with phenobarbital compared with clonidine, in combination with morphine, for the treatment of NOWS. METHODS: We performed a retrospective cohort study of infants with NOWS from 30 hospitals. The primary outcome measures were the length of hospital stay, duration of opioid treatment, and peak morphine dose. Outcomes were compared by group by using analysis of variance and multivariable linear regression controlling for relevant confounders. RESULTS: Of 563 infants with NOWS treated with morphine, 32% (n = 180) also received a secondary medication. Seventy-two received phenobarbital and 108 received clonidine. After adjustment for covariates, length of hospital stay was 10 days shorter, and, in some models, duration of morphine treatment was 7.5 days shorter in infants receiving phenobarbital compared with those receiving clonidine, with no difference in peak morphine dose. Infants were more likely to be discharged from the hospital on phenobarbital than clonidine (78% vs 29%, P,.0001). CONCLUSIONS: Among infants with NOWS receiving morphine and secondary therapy, those treated with phenobarbital had shorter length of hospital stay and shorter morphine treatment duration than clonidine-treated infants but were discharged from the hospital more often on secondary medication. Further investigation is warranted to determine if the benefits of shorter hospital stay and shorter duration of morphine therapy justify the possible neurodevelopmental consequences of phenobarbital use in infants with NOWS.
AB - BACKGROUND AND OBJECTIVES: Despite the neonatal opioid withdrawal syndrome (NOWS) epidemic in the United States, evidence is limited for pharmacologic management when first-line opioid medications fail to control symptoms. The objective with this study was to evaluate outcomes of infants receiving secondary therapy with phenobarbital compared with clonidine, in combination with morphine, for the treatment of NOWS. METHODS: We performed a retrospective cohort study of infants with NOWS from 30 hospitals. The primary outcome measures were the length of hospital stay, duration of opioid treatment, and peak morphine dose. Outcomes were compared by group by using analysis of variance and multivariable linear regression controlling for relevant confounders. RESULTS: Of 563 infants with NOWS treated with morphine, 32% (n = 180) also received a secondary medication. Seventy-two received phenobarbital and 108 received clonidine. After adjustment for covariates, length of hospital stay was 10 days shorter, and, in some models, duration of morphine treatment was 7.5 days shorter in infants receiving phenobarbital compared with those receiving clonidine, with no difference in peak morphine dose. Infants were more likely to be discharged from the hospital on phenobarbital than clonidine (78% vs 29%, P,.0001). CONCLUSIONS: Among infants with NOWS receiving morphine and secondary therapy, those treated with phenobarbital had shorter length of hospital stay and shorter morphine treatment duration than clonidine-treated infants but were discharged from the hospital more often on secondary medication. Further investigation is warranted to determine if the benefits of shorter hospital stay and shorter duration of morphine therapy justify the possible neurodevelopmental consequences of phenobarbital use in infants with NOWS.
UR - https://www.scopus.com/pages/publications/85102538349
U2 - 10.1542/PEDS.2020-017830
DO - 10.1542/PEDS.2020-017830
M3 - Article
C2 - 33632932
AN - SCOPUS:85102538349
SN - 0031-4005
VL - 147
JO - Pediatrics
JF - Pediatrics
IS - 3
M1 - e2020017830
ER -