Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome.

Autor:	Merhar SL; Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; stephanie.merhar@cchmc.org., Ounpraseuth S; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas., Devlin LA; Department of Pediatrics, University of Louisville, Louisville, Kentucky., Poindexter BB; Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio., Young LW; Larner College of Medicine at the University of Vermont, Burlington, Vermont., Berkey SD; Alaska Native Tribal Health Consortium, Anchorage, Alaska., Crowley M; Rainbow Babies and Children's Hospital, Cleveland, Ohio., Czynski AJ; Department of Pediatrics, Women and Infant's Hospital, Providence, Rhode Island., Kiefer AS; Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia., Whalen BL; Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire., Das A; RTI International, Rockville, Maryland., Fuller JF; University of New Mexico Health Sciences Center, Albuquerque, New Mexico., Higgins RD; National Institute of Child Health and Human Development, Bethesda, Maryland and George Mason University, Fairfax, Virginia., Thombre V; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas., Lester BM; Center for the Study of Children at Risk, Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island., Smith PB; Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina., Newman S; Nebraska Medical Center, Omaha, Nebraska., Sánchez PJ; Nationwide Children's Hospital, College of Medicine, The Ohio State University, Columbus, Ohio., Smith MC; Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia; and., Simon AE; Environmental Influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health, Rockville, Maryland.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2021 Mar; Vol. 147 (3).
DOI:	10.1542/peds.2020-017830
Abstrakt:	Background and Objectives: Despite the neonatal opioid withdrawal syndrome (NOWS) epidemic in the United States, evidence is limited for pharmacologic management when first-line opioid medications fail to control symptoms. The objective with this study was to evaluate outcomes of infants receiving secondary therapy with phenobarbital compared with clonidine, in combination with morphine, for the treatment of NOWS. Methods: We performed a retrospective cohort study of infants with NOWS from 30 hospitals. The primary outcome measures were the length of hospital stay, duration of opioid treatment, and peak morphine dose. Outcomes were compared by group by using analysis of variance and multivariable linear regression controlling for relevant confounders. Results: Of 563 infants with NOWS treated with morphine, 32% ( n = 180) also received a secondary medication. Seventy-two received phenobarbital and 108 received clonidine. After adjustment for covariates, length of hospital stay was 10 days shorter, and, in some models, duration of morphine treatment was 7.5 days shorter in infants receiving phenobarbital compared with those receiving clonidine, with no difference in peak morphine dose. Infants were more likely to be discharged from the hospital on phenobarbital than clonidine (78% vs 29%, P < .0001). Conclusions: Among infants with NOWS receiving morphine and secondary therapy, those treated with phenobarbital had shorter length of hospital stay and shorter morphine treatment duration than clonidine-treated infants but were discharged from the hospital more often on secondary medication. Further investigation is warranted to determine if the benefits of shorter hospital stay and shorter duration of morphine therapy justify the possible neurodevelopmental consequences of phenobarbital use in infants with NOWS. Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Whalen is a codeveloper of the ESC Care Tool; Children’s Hospital at Dartmouth-Hitchcock is one of the institutions on the ESC Care Tool copyright; the other authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2021 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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