PC1121: Neonatal Opioid Withdrawal Syndrome in Buprenorphine-exposed versus Methadone-exposed Infants Managed Using Eat, Sleep, Console

Background: Neonatal opioid withdrawal syndrome (NOWS) presents with a constellation of neurological and gastrointestinal signs in opioid-exposed neonates. Prior studies have consistently reported a milder NOWS phenotype in buprenorphine versus methadone-exposed neonates managed with traditional Finnegan Neonatal Abstinence Scoring System (FNASS)-guided treatment. The Eat, Sleep, Console (ESC) approach for the treatment of NOWS has gained popularity recently. However, no study has yet explored the outcomes of neonates exposed to buprenorphine versus methadone managed with the ESC approach.

We compared infants with NOWS exposed prenatally to buprenorphine versus methadone who were managed using ESC when assessing:
1) Average length of stay (ALOS)
2) Peak daily FNASS score
3) Proportion of patients treated pharmacologically
4) Proportion of breastfed infants

Methods: We retrospectively compared outcomes for buprenorphine- versus methadone-exposed infants on our general inpatient unit from February 2013-July 2019 who were managed with the ESC approach (n=299; 51 exposed to buprenorphine, 248 exposed to methadone). Infants well-managed on ESC were defined as 1) able to eat at least 1 oz per feed or breastfeed well; 2) sleep undisturbed for at least 1 hour; and 3) to be consoled within 10 minutes when crying. Infants not achieving more than 1 of these goals were further optimized using these nonpharmacologic interventions or were started on morphine treatment. Outcome measures were assessed by two fixed-effect variables (buprenorphine vs methadone) and analyzed using negative binomial regression with incidence rate ratios (ALOS), quantile regression (peak FNASS scores), simple logistic regression (morphine administration rates), and linear regressions (breastfeeding rates).

Results: When compared with methadone-exposed infants, buprenorphine-exposed infants had shorter ALOS (4.8±0.3 vs 6.1±0.2 days, IRR=0.786, 95% CI [0.67, 0.92]), lower peak FNASS scores (8.9±0.7 vs 11.3±0.3, p< 0.01) and higher breastfeeding rates (35.2%±4.8 vs 21.5%±1.8, p< 0.01). There were no differences in rates of morphine administration between groups.

Conclusion: Infants exposed to buprenorphine and subsequently managed with ESC fared better than those exposed to methadone. Utilizing ESC in conjunction with maternal buprenorphine treatment can optimize neonatal outcomes and decrease hospital expenditures.