Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome.
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% (
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.
American Academy of Pediatrics
Merhar, Stephanie L; Songthip Ounpraseuth; Lori A Devlin; Brenda B Poindexter; Leslie W Young; Sean D Berkey; Moira Crowley; Adam J Czynski; Autumn S Kiefer; Bonny L Whalen; Abhik Das; Janell F Fuller; Rosemary D Higgins; Vaishali Thombre; Barry M Lester; P Brian Smith; Sarah Newman; Pablo J Sánchez; M Cody Smith; and Alan E Simon.
"Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome.."