Veeral N Tolia1, Karna Murthy2, Monica M Bennett3, Rachel G Greenberg4, Daniel K Benjamin5, P Brian Smith4, Reese H Clark6. 1. Department of Neonatology, Baylor University Medical Center, Dallas, TX; Pediatrix Medical Group, Baylor Scott & White Health, Dallas, TX. Electronic address: veeral.tolia@baylorhealth.edu. 2. Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, IL; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 3. Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX. 4. Division of Neonatology, Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC. 5. Department of Economics, Clemson University, Clemson, SC. 6. Pediatrix Medical Group, Greenville Memorial Hospital, Greenville, SC; Center for Research, Education, and Quality, Mednax, Inc, Sunrise, FL.
Abstract
OBJECTIVE: To estimate the relationship of initial pharmacotherapy with methadone or morphine and length of stay (LOS) in infants with neonatal abstinence syndrome (NAS) admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: From the Pediatrix Clinical Data Warehouse database, we identified all infants born at ≥36 weeks of gestation between 2011 and 2015 who were diagnosed with NAS (International Classification of Diseases, Ninth Revision code 779.5) and treated with methadone or morphine in the first 7 days of life. We used multivariable Cox proportional hazards regression analysis to quantify the association between initial treatment and LOS after adjusting for maternal age, maternal race/ethnicity, maternal drug use, maternal smoking, gestational age, small for gestational age status, inborn status, and discharge year. RESULTS: We identified a total of 7667 eligible infants, including 1187 treated with methadone (15%) and 6480 treated with morphine (85%). Birth weight, gestational age, and sex were similar in the 2 groups. Methadone treatment was associated with a 22% shorter median LOS (18 days [IQR, 11-30 days] vs 23 days [IQR, 16-33]; P < .001) and a 19% shorter median NICU stay (17 days [IQR, 10-29 days] vs 21 days [IQR, 14-36 days]; P < .001). After adjustment, methadone was associated with a shorter LOS (hazard ratio for discharge, 1.24; 95% CI, 1.11-1.37; P < .001) CONCLUSION: Among infants born at ≥36 weeks of gestation with NAS, initial methadone treatment was associated with a shorter LOS compared with morphine treatment. Future prospective comparative effectiveness trials to treat infants with NAS are needed to verify this observation.
OBJECTIVE: To estimate the relationship of initial pharmacotherapy with methadone or morphine and length of stay (LOS) in infants with neonatal abstinence syndrome (NAS) admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: From the Pediatrix Clinical Data Warehouse database, we identified all infants born at ≥36 weeks of gestation between 2011 and 2015 who were diagnosed with NAS (International Classification of Diseases, Ninth Revision code 779.5) and treated with methadone or morphine in the first 7 days of life. We used multivariable Cox proportional hazards regression analysis to quantify the association between initial treatment and LOS after adjusting for maternal age, maternal race/ethnicity, maternal drug use, maternal smoking, gestational age, small for gestational age status, inborn status, and discharge year. RESULTS: We identified a total of 7667 eligible infants, including 1187 treated with methadone (15%) and 6480 treated with morphine (85%). Birth weight, gestational age, and sex were similar in the 2 groups. Methadone treatment was associated with a 22% shorter median LOS (18 days [IQR, 11-30 days] vs 23 days [IQR, 16-33]; P < .001) and a 19% shorter median NICU stay (17 days [IQR, 10-29 days] vs 21 days [IQR, 14-36 days]; P < .001). After adjustment, methadone was associated with a shorter LOS (hazard ratio for discharge, 1.24; 95% CI, 1.11-1.37; P < .001) CONCLUSION: Among infants born at ≥36 weeks of gestation with NAS, initial methadone treatment was associated with a shorter LOS compared with morphine treatment. Future prospective comparative effectiveness trials to treat infants with NAS are needed to verify this observation.
Authors: Kathleen M Doherty; Theresa A Scott; Anna Morad; Travis Crook; Elizabeth McNeer; Kim S Lovell; James C Gay; Stephen W Patrick Journal: Pediatrics Date: 2020-12-02 Impact factor: 7.124
Authors: Miriam Moreno-Ramos; Mercedes Sánchez-Barba; Rubén García Sánchez; José Antonio Mirón-Canelo; Veronica González-Nuñez Journal: Children (Basel) Date: 2021-12-30