Treatment of Neonatal Abstinence Syndrome in Preterm and Term Infants

Abstract

Objective:

Neonatal abstinence syndrome (NAS) is treated with a variety of drug preparations. With the optional treatment of NAS with chloral hydrate, phenobarbital or morphine the cumulative drug consumption of the mentioned drugs, the length of hospital stay and treatment duration was evaluated in preterm and term neonates.

Methods:

Retrospective, uncontrolled study which evaluates different therapies of neonatal abstinence syndrome (NAS) in preterm and term neonates.

Results:

During the past 16 years data were obtained from medical records of 51 neonates with NAS; 9 preterm and 35 term neonates were evaluated and 7 were excluded because of incomplete data sets. 31 (72.1%) received a pharmacological treatment (6 preterm and 25 term neonates). Treatment started at 4.3 [3.3–5.3] d. Mean duration of treatment was 11.7 [6.6–16.7] d. In our study chloral hydrate (ch) and phenobarbital (pb) were first line medication escalated by the morphine (mp) solution. Mean cumulative dosage of ch was 643.5 [260.3–1 026.7] mg, of pb 53.2 [19.7–86.8] mg and of mp 4.22 [0–8.99] mg.

Conclusion:

Our study group showed similar treatment duration and length of hospital stay compared to other studies. The cumulative dose of mp was lower compared to most studies. This benefit resulted at the expense of a further medication with pb and ch. However, 6 of 9 preterm neonates needed significantly less pharmacological therapy compared to term neonates indicating less susceptibility of immature brain to abstinence of maternalo­pioids.

Zusammenfassung

Hintergrund:

Das neonatale Entzugssyndrom (NAS) wird mit unterschiedlichen Medikamenten-gruppen behandelt. In unserer Klinik erfolgte die Behandlung mit Chloralhydrat (ch), Phenobarbital (pb) und/oder Morphin (mp). Es wurde die kumulative Medikamentendosis, die Länge des Kran­kenhausaufenthaltes und die Behandlungsdauer bei Frühgeborenen (FG) und Neugeborenen (NG) ausgewertet.

Methodik:

In einer retrospektiven, unkontrollierten Studie wurde die Notwendigkeit und Wirkung von unterschiedlichen Medikamenten auf Früh- und Neugeborene mit NAS untersucht.

Ergebnisse:

Während der letzten 16 Jahre wurden 51 Neugeborene behandelt, von denen 7 wegen unvollständiger Daten ausgeschlossen wurden. Von den 44 Patienten waren 9 Frühgeborene. 31 (72,1%) benötigten eine medikamentöse Therapie (6 FG; 25 NG). Der Therapiebeginn lag bei 4,3 [3,3–5,3] Tagen, und die mittlere Dauer betrug 11,7 [6,6–16,7] Tage. Die mittlere Dosis betrug von ch 643,5 [260,3–1 026,7] mg, von pb 53,2 [19,7–86,8] mg und von mp 4,22 [0–8,99] mg.

Schlussfolgerungen:

Die Behandlungsdauer und die Krankenhaustage waren mit anderen Studien vergleichbar. Allerdings war die kumulative mp-Dosis geringer, was auf die zusätzliche Gabe von ch und pb zurückzuführen ist. Die 6 FG brauchten weniger Medikamente und eine kürzere Therapie. Dies mag ein Hinweis sein, dass das unreife Gehirn auf den Entzug mütterlicher Opioide weniger empfindlich reagiert.

Key words

neonatal abstinence ­syndrome - preterms - term infant - drug therapy

Schlüsselwörter

neonatales Entzugsyndrom - Frühgeborene - Neugeborene - Therapie

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