Buprenorphine is effective in treating neonatal abstinence syndrome

Reference

Disher T, Gullickson C, Singh B, et al. Pharmacological treatments for neonatal abstinence syndrome: a systematic review and network meta-analysis. JAMA Pediatr 2019 Jan 22. [Epub ahead of print]

Synopsis

Neonatal abstinence syndrome is a group of symptoms (eg, jitteriness, a high-pitched cry, diaphoresis, diarrhea, and so forth) that occur in neonates who have been exposed to opioids during pregnancy. These investigators performed a network meta-analysis to determine which of the available therapies are most effective in managing these abstinence symptoms. They searched several databases and clinical trials registries to identify randomized trials that compared at least 2 pharmacologic agents in the management of neonatal abstinence syndrome. In addition, these investigators contacted the authors of published posters to see if they subsequently published their work. Two reviewers independently evaluated studies for inclusion and assessed the risk of bias of the included studies. They resolved discrepancies through consensus and, when needed, a third party. Ultimately, they included 18 small trials with 25 to 139 participants (N =1072). The authors report methodologic variability among the trials: types of protocols, explicit versus implicit outcome assessments, thresholds for co-interventions, and so forth. Overall, very few of the studies were at low risk of bias. With the amount of methodologic heterogeneity and poor quality of studies, one might argue that it makes no sense to pool the data. These authors threw caution to the wind and chose to do a network meta-analysis. The authors main outcome of interest was the duration of therapy, and they used length of stay, the need for adjuvant therapies, and adverse events as secondary outcomes. They did not directly assess the severity of abstinence symptoms. The included studies evaluated buprenorphine, clonidine, diluted tincture of opium, diluted tincture of opium plus clonidine, morphine, methadone, and phenobarbital, but buprenorphine and morphine had the most robust effects. With the aforementioned limitations, the authors' analysis concludes that sublingual buprenorphine had a shorter duration of treatment (by nearly 13 days) and a shorter length of stay (by nearly 12 days) than morphine. There was no difference, however, in the need for adjuvant therapy.