Opiate Treatment for Opiate Withdrawal in Newborn Infants

A Cochrane review [Abstract] 1 included 16 studies with a total of 1100 infants. The studies enrolled infants of mothers who had used opiates with or without other drugs during pregnancy.

• Opiate (morphine) vs supportive care only: One study found no significant effect on treatment failure (RR 1.29, 95% CI 0.41 to 4.07), a significant increase in hospital stay (MD 15.0 days, 95% CI 8.9 to 21.1) and significant reductions in time to regain birthweight (MD -2.8 days, 95% -5.3 to -0.3) and duration of supportive care (MD -197.2 minutes/day, 95% CI -274.2 to -120.3).
• Morphine versus methadone: There was no difference in treatment failure (RR 1.59, 95% CI 0.95 to 2.67; 2 studies, n=147). Two studies found an increase in days treatment while one did not.
• Morphine versus sublingual buprenorphine: There was no difference in treatment failure (RR 0.79, 95% CI 0.36 to 1.74; 3 studies, n=113). Hospitalisation (MD 11.45, 95% CI 5.89 to 17.01; 3 studies, n=113 infants), and days of treatment (MD 12.79, 95% CI 7.57 to 18.00; 3 studies, n=112 infants) were increased.
• Opiate vs phenobarbitone: Meta-analysis of four studies found no significant difference in treatment failure (RR 0.76, 95% CI 0.51 to 1.11). Single studies reported reduction in treatment failure, reduction in duration of treatment and admission to the nursery or reduction in seizures in favour of opiate treatment.
• Opiate vs diazepam: Treatment failure was reduced (RR 0.43, 95% CI 0.23 to 0.80; 2 studies, n=86) with the use of opiate.

Reviewers' conclusions: Opiates, as compared to supportive care only, appear to reduce the time to regain birth weight and reduce the duration of supportive care, but increase the duration of hospital stay; there is no evidence of effect on treatment failure. When compared to phenobarbital, opiates may reduce the incidence of seizures but, overall, there is no evidence of effect on treatment failure. When compared to diazepam, opiates reduce the incidence of treatment failure.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and lack of blinding) and imprecision (wide confidence intervals).

References

• Zankl A, Martin J, Davey JG et al. Opioid treatment for opioid withdrawal in newborn infants. Cochrane Database Syst Rev 2021;(7):CD002059. [PubMed]