Opiates Better Than Sedatives For Treating Newborns In Withdrawal

Opiates appear to better "ameliorate the withdrawal, facilitatefeeding and potentially reduce the likelihood of seizures," accordingto two new systematic reviews done by David Osborn, a neonatologist atthe Royal Prince Alfred Hospital in Sydney, Australia, and colleagues.

The researchers also found that infants treated with opiatesregained birth weight more quickly than those who only receivedsupportive care.

According to their analysis, the use of opiates instead ofsedatives or supportive care alone shortens the duration of supportivecare by an average of four days. When compared to diazepam (Valium),opiates reduce the incidence of treatment failure.

However, infants treated with opiates had longer hospitalstays than those treated with phenobarbitone, the sedative most oftenused in these cases. When sedatives only were compared, phenobarbitonewas more likely than diazepam to reduce treatment failure.

The reviews appear in the July issue of The Cochrane Library, apublication of The Cochrane Collaboration, an internationalorganization that evaluates medical research. Systematic reviews drawevidence-based conclusions about medical practice after consideringboth the content and quality of existing medical trials on a topic.

The reviews included 13 studies with a total of 890 infants ofmothers who had used opiates with or without other drugs (includingantidepressants, sleep aids and marijuana) during pregnancy.Researchers say two of the studies may have included identicalpatients.

Newborns suffering from neonatal abstinence syndrome (NAS)exhibit seizures, poor feeding, diarrhea and vomiting that lead toexcessive weight loss and dehydration, sleeping problems and fever.Disruption in the mother-child bonding process has also been reported,and there is an increased risk of sudden infant death syndrome.

In the studies, newborns suffering from NAS were treated withopiates (morphine, methadone, paregoric, or tincture of opium),sedatives (phenobarbitone, diazepam or chlorpromazine) or supportivecare only. None of the studies compared opiate treatment with placebo.

Of the randomized and "quasi-random" studies analyzed, "theevidence is not high quality," Osborn says, and unanswered questionsremain. For example, in infants treated with an opiate, the addition ofphenobarbitone may reduce withdrawal severity, but more research isneeded using a higher initial dose of opiate, and to examine theeffects of phenobarbitone on infant development.

In the 1999 U.S. National Household Survey on Drug Abuse, 3.4percent of pregnant women reported illicit drug use in the past month,which according to authors represents some 3,000 current pregnantheroin users in the U.S., similar to Australian figures. Between 48percent and 94 percent of infants exposed to opiates in the uterusdevelop clinical signs of withdrawal

"The interesting information," Osborn says, "suggests thatthese infants can be treated without admission to the special carenursery unless withdrawal is complicated and that this is facilitatedby use of morphine instead of phenobarbitone. This helps keep mothersand babies together, helps in educating the mothers in mothercraftskills and to recognize signs of infant withdrawal, and helps inassessment of the quality of the mother-infant interaction in asupervised environment."

Osborn DA, Jeffery HE, Cole M. Opiate treatment for opiatewithdrawal in newborn infants. The Cochrane Database of SystematicReviews 2005, Issue 3Osborn DA, Jeffery HE, Cole MJ. Sedatives for opiate withdrawal innewborn infants. The Cochrane Database of Systematic Reviews 2005,Issue 3

The Cochrane Collaboration is an international nonprofit,independent organization that produces and disseminates systematicreviews of health care interventions and promotes the search forevidence in the form of clinical trials and other studies ofinterventions. Visit http://www.cochrane.org for more information.