Antenatal methadone vs buprenorphine exposure and length of hospital stay in infants admitted to the intensive care unit with neonatal abstinence syndrome

被引:22
|
作者
Tolia, V. N. [1 ,2 ]
Murthy, K. [3 ,4 ]
Bennett, M. M. [5 ]
Miller, E. S. [6 ]
Benjamin, D. K. [7 ]
Smith, P. B. [8 ]
Clark, R. H. [9 ,10 ]
机构
[1] Baylor Univ, Med Ctr, Dept Pediat, Div Neonatol, Dallas, TX 75246 USA
[2] Pediat Med Grp, Dallas, TX USA
[3] Northwestern Univ, Feinberg Sch Med, Dept Pediat, Div Neonatol, Chicago, IL 60611 USA
[4] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL USA
[5] Off Chief Qual Officer, Baylor Scott & White Hlth, Dallas, TX USA
[6] Northwestern Univ, Dept Obstet & Gynecol, Feinberg Sch Med, Div Maternal Fetal Med, Chicago, IL 60611 USA
[7] Clemson Univ, Dept Econ, Clemson, SC USA
[8] Duke Univ, Dept Pediat, Durham, NC 27706 USA
[9] Greenville Mem Hosp, Pediat Med Grp, Greenville, SC USA
[10] Mednax Inc, Ctr Res Educ & Qual, Sunrise, FL USA
关键词
INCREASING INCIDENCE; OPIOID DEPENDENCE; PREGNANT-WOMEN; OUTCOMES; COHORT; STATES; MORPHINE;
D O I
10.1038/jp.2017.157
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
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. 36 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. 36 weeks' gestation with NAS, antenatal buprenorphine exposure was associated with a decreased length of stay relative to antenatal methadone exposure.
引用
收藏
页码:75 / 79
页数:5
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