July 17, 2014

Care for newborns with drug withdrawal uneven: study

In the United States, one infant is born each hour with drug withdrawal, known as neonatal abstinence syndrome (NAS), after being exposed to opioid medications like oxycodone in utero.

In the United States, one infant is born each hour with drug withdrawal, known as neonatal abstinence syndrome (NAS), after being exposed to opioid medications like oxycodone in utero.

Infants with NAS can have seizures, difficulty feeding, respiratory complications and low birth weights. Even though they are becoming more common, the medical care delivered to infants with the syndrome is strikingly variable, according to a study published in the Journal of Perinatology.

In addition to finding widespread variation in treatment, the study also found that infants treated with methadone had a shorter length of treatment and length of stay when compared to other treatment methods for infants with NAS.

The study, which was supported by the Robert Wood Johnson Foundation Clinical Scholars Program, is a collaboration between the Children’s Hospital of Philadelphia, Cincinnati Children’s Hospital and the University of Michigan Health System.

Stephen Patrick M.D.

Lead author Stephen Patrick M.D., now an assistant professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt, completed the work as a Neonatology fellow at the University of Michigan.

The authors studied data from 1,424 infants with NAS at 14 major children’s hospitals, finding significant variations in treatment for NAS.

“We found that, even among large children’s hospitals, only a couple of hospitals followed the same method of treatment more than 80 percent of the time,” Patrick said.

“I think, overall, what this calls for is standardizing how we care for these infants as the American Academy of Pediatrics and World Health Organization suggests; making sure we are giving the same treatment using the best possible evidence that we can to improve outcomes for our babies and families.”

Recently, there has been a rapid increase in the number of infants born with NAS in the United States. Tennessee has been particularly affected. In some areas of the state, infants born with NAS make up 5 percent of all births, Patrick said.

“Throughout the United States we have seen a fourfold increase in sales of opioid pain relievers and, from that, we have seen complications in women and pregnant women that include anything from overdose deaths to treatment facility admissions to neonatal abstinence syndrome,” he said. “I think the recent rise that we have seen in Tennessee can be attributed to the increase in sales and use of opioid pain relievers.”

The study looked at a combination of hospital administration and pharmacy data to evaluate differences in drug treatment for infants with NAS. Six hospitals primarily used methadone, six prescribed morphine and two used phenobarbital. Methadone showed the best outcome.

Though more research is needed, Patrick said it is likely that methadone-treated infants will have fewer instances where they show signs of withdrawal.

Fewer signs of withdrawal could decrease the need for opioid dose escalations, potentially shortening their length of treatment and hospital stay.

“The problem with neonatal abstinence syndrome is there is not a lot of research to inform what we do. We hope to add to the evidence by comparing medications and by showing how variable care is for this vulnerable population. I hope our work will serve as a call to hospitals caring for infants with NAS to standardize how they care for patients,” Patrick said.