TY - JOUR
T1 - Antenatal methadone vs buprenorphine exposure and length of hospital stay in infants admitted to the intensive care unit with neonatal abstinence syndrome
AU - Tolia, V. N.
AU - Murthy, K.
AU - Bennett, M. M.
AU - Miller, E. S.
AU - Benjamin, D. K.
AU - Smith, P. B.
AU - Clark, R. H.
N1 - Funding Information:
Data for this retrospective cohort study were obtained from the Pediatrix Clinical Data Warehouse (CDW), a large multicenter, de-identified data set that has been used to define and evaluate national trends in NICU diagnoses and therapies.15 The CDW is generated from BabySteps, a standardized software tool. Clinical providers enter daily data into BabySteps that generates medical documentation (for example, admission, progress, and discharge notes, and billing worksheets). At the end of each infant’s NICU hospitalization, these data are extracted and added to the CDW data set. The CDW includes data from approximately 20% of all infants admitted to NICUs in the United States. This study was reviewed and approved by the Institutional Review Board at the Baylor Research Institute (Dallas, TX, USA) and the Research Advisory Committee at Mednax (Sunrise, FL, USA).
Publisher Copyright:
© 2018 Nature America, Inc., part of Springer Nature. All rights reserved.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective:Antenatal exposure to methadone or buprenorphine often causes neonatal abstinence syndrome (NAS) in newborns. However, comparative effects on affected infants' hospital courses are inconclusive. We sought to estimate the relationship of antenatal exposure with methadone or buprenorphine and infants' length of stay among hospitalized infants with NAS.Study Design:This was a retrospective cohort study of hospitalized infants with NAS with either maternal exposure. Eligible infants were singleton infants born ≤3/436 weeks' gestation and diagnosed with NAS<7 days of age between 2011 and 2014 in the Pediatrix Clinical Data Warehouse. Infant with congenital anomalies and those of multiple gestation were excluded.Results:Of 3364 eligible infants, 2202 (65%) were exposed to methadone and 1162 (34%) to buprenorphine. Infants exposed to buprenorphine had a lower rate of pharmacologic treatment for NAS (88 vs 91%, P<0.001). Median length of hospital stay was shorter among infants exposed to buprenorphine (21 days (inter-quartile range; 13-31) vs methadone (24 days (15-38), P<0.0001)). On multivariable Cox proportional hazard analyses, buprenorphine was associated with a shorter length of stay (hazard ratio (HR)=1.47 (95% confidence interval (CI): 1.32-1.62, P<0.001) after controlling for maternal age, parity, race or ethnicity, prenatal care, smoking status, use of antidepressants, use of benzodiazepines, and infant gestational age, small for gestational age status, cesarean delivery, sex, out born status, type of pharmacotherapy, breast milk use, year and center. We observed similar results in model using infants matched 1:1 with propensity scores for antenatal medication exposure (HR 1.39 for buprenorphine, CI 1.32-1.62, P<0.001).Conclusion:Among infants born ≥ 3/436 weeks' gestation with NAS, antenatal buprenorphine exposure was associated with a decreased length of stay relative to antenatal methadone exposure.
AB - Objective:Antenatal exposure to methadone or buprenorphine often causes neonatal abstinence syndrome (NAS) in newborns. However, comparative effects on affected infants' hospital courses are inconclusive. We sought to estimate the relationship of antenatal exposure with methadone or buprenorphine and infants' length of stay among hospitalized infants with NAS.Study Design:This was a retrospective cohort study of hospitalized infants with NAS with either maternal exposure. Eligible infants were singleton infants born ≤3/436 weeks' gestation and diagnosed with NAS<7 days of age between 2011 and 2014 in the Pediatrix Clinical Data Warehouse. Infant with congenital anomalies and those of multiple gestation were excluded.Results:Of 3364 eligible infants, 2202 (65%) were exposed to methadone and 1162 (34%) to buprenorphine. Infants exposed to buprenorphine had a lower rate of pharmacologic treatment for NAS (88 vs 91%, P<0.001). Median length of hospital stay was shorter among infants exposed to buprenorphine (21 days (inter-quartile range; 13-31) vs methadone (24 days (15-38), P<0.0001)). On multivariable Cox proportional hazard analyses, buprenorphine was associated with a shorter length of stay (hazard ratio (HR)=1.47 (95% confidence interval (CI): 1.32-1.62, P<0.001) after controlling for maternal age, parity, race or ethnicity, prenatal care, smoking status, use of antidepressants, use of benzodiazepines, and infant gestational age, small for gestational age status, cesarean delivery, sex, out born status, type of pharmacotherapy, breast milk use, year and center. We observed similar results in model using infants matched 1:1 with propensity scores for antenatal medication exposure (HR 1.39 for buprenorphine, CI 1.32-1.62, P<0.001).Conclusion:Among infants born ≥ 3/436 weeks' gestation with NAS, antenatal buprenorphine exposure was associated with a decreased length of stay relative to antenatal methadone exposure.
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U2 - 10.1038/jp.2017.157
DO - 10.1038/jp.2017.157
M3 - Article
C2 - 29048415
AN - SCOPUS:85040835591
SN - 0743-8346
VL - 38
SP - 75
EP - 79
JO - Journal of Perinatology
JF - Journal of Perinatology
IS - 1
ER -