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January 22, 2019

Pharmacologic Treatment for Neonatal Abstinence Syndrome: Which Medication Is Best?

Author Affiliations
  • 1Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
  • 2Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
JAMA Pediatr. 2019;173(3):221-223. doi:10.1001/jamapediatrics.2018.5029

Cases of neonatal abstinence syndrome (NAS) secondary to in utero opioid exposure have increased significantly over the past decade, with recent data from the US Pediatric Health Information System showing an incidence as high as 20 cases per 1000 live births.1 An estimated 50% to 80% of infants with NAS are treated pharmacologically, with most of these infants cared for within newborn intensive care units. In 2012, these pharmacologically treated infants had a mean length of hospital stay (LOS) of 23.0 days, with an average hospitalization charge of $93 400 per infant.2 There continues to be wide variation in care practices, including pharmacologic agents used to treat NAS, with no consensus as to which medication regimen is best.3,4 To our knowledge, high-quality studies, such as randomized clinical trials (RCTs) and meta-analyses of management strategies for NAS, are very limited, providing little guidance to inform best practice recommendations.3 Currently, the most common first-line medications used to treat NAS include morphine, methadone, and buprenorphine; phenobarbital and clonidine are the most commonly used adjunctive agents.3,4