Symptom-triggered drugs for neonatal opioid withdrawal shorten stays in hospital

A study conducted by researchers at the Boston Medical Center (BMC) showed that taking drugs based on symptoms of neonatal opioid withdrawal syndrome instead of infants receiving fixed-program treatment over a long period of time reduced their duration. stay in the hospital. The results, published in Hospital pediatrics, indicate that following the new symptom-triggered approach – developed by BMC – for drug delivery could be a more effective intervention for these infants and help reduce unnecessary exposure to medications.

Neonatal opioid withdrawal syndrome (NOWS) affects infants exposed to opioids in utero. With the increase in prescription and non-prescription opioid use in the United States, which has not spared pregnant women, the NUS rate has increased fivefold over the last decade. Approximately 50 to 80% of opioid-exposed infants require medication to manage their withdrawal symptoms, which usually appear two to three days after birth and may include irritability, eating and sleeping disorders, diarrhea, stiffness Muscular and soothing. The drugs currently used to manage these symptoms include methadone, morphine and buprenorphine. The average hospital stay for IDNU infants treated with drugs is 23 days and costs approximately $ 93,000.

During postpartum hospitalization, all infants with NOWS are evaluated according to their ability to eat, sleep and be comforted every four hours. At BMC, clinicians use non-pharmacological care interventions, including bed-side parenting, bad-feeding and in-room accommodation, as the first-line treatment of NOWS, who have shown that studies reduced the need for drugs and the length of stay in the hospital. If an infant is having difficulty with these essential functions after using non-pharmacological treatments, the health care team determines whether the medication is the next appropriate step.

In this study, researchers investigated two treatment approaches for infants requiring treatment for NOWS: between June 2016 and November 2017, a fixed-hour medication approach was used, consisting of administering methadone every eight hours, the traditional slow cone to treat NOWS. Between December 2017 and May 2018, researchers implemented the symptom-based approach, developed by clinical researchers at BMC, as a new way of treating NOWS syndrome with a focus on treatment of symptoms and comfort of infants. This approach reduces the incidence of opioid dependence, which can sometimes occur with the traditional fixed-drug approach.

Infants treated according to the symptom – triggered approach had a median length of stay of 10.5 days, compared with 17 days for the fixed – calendar approach. The group at the origin of the symptoms had 5.6 days less treatment with methadone compared to the group with fixed drug treatment. In addition, the percentage of infants successfully treated with the symptom-triggered approach was 100% at the end of the study period, and no adverse events resulted from this therapeutic approach.

"Our study showed that treating acute symptoms with medication and not having a fixed schedule with a long incline not only improves patient outcomes, but shortens their hospitalizations and reduces exposure to opioid drugs," said Elisha Wachman, MD, the corresponding author of the study. Neonatologist at the BMC and Associate Professor of Pediatrics at the Faculty of Medicine at Boston University. "This new approach gives priority to non-pharmacological care for infants with withdrawal symptoms and reduces the risk of unintended dependence that occurs frequently when infants are placed on methadone or morphine for prolonged periods."

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