Buprenorphine Dose Does Not Impact Severity of Neonatal Opioid Withdrawal Syndrome

Maternal exposure to opioid agonist treatment can result in neonatal opioid withdrawal syndrome (NOWS) in the newborn. This retrospective analysis examined severity of NOWS among mother-newborn dyads presenting to a single institution over a 16-year period. The primary outcomes were requirement for morphine treatment (yes/no), peak neonatal opioid withdrawal score, peak morphine dose, time to morphine start, days receiving morphine, and total duration of hospital stay.

• Of 89 mother-infant dyads included in the study, NOWS incidence requiring morphine was 44%.
• For infants requiring morphine, there was a mean 55 hours to morphine start, mean 16 days receiving morphine, and mean of 20 days hospital stay.
• NOWS requiring morphine treatment occurred in 49% and 41% of infants of mothers receiving ≤8 mg/day buprenorphine versus >8 mg/day, respectively.
• There were no associations of maternal buprenorphine dose with peak NOWS score, NOWS severity requiring morphine, time to morphine start, peak morphine dose, or days receiving morphine. Only exclusive breastfeeding was significantly associated with neonatal outcomes, specifically lower odds of morphine treatment (odds ratio, 0.24).

Comments: Although this study was limited by small sample size and possibility of changes to NOWS treatment protocols over the 16-year study period, these data suggest that buprenorphine dose does not impact severity of NOWS among infants born to mothers prescribed buprenorphine during pregnancy.

Jeanette M. Tetrault, MD

Reference: Wong J, Saver B, Scanlan JM, et al. Does maternal buprenorphine dose affect severity or incidence of neonatal abstinence syndrome? J Addict Med. 2018;12(6):435–441.