Morphine versus clonidine for neonatal abstinence syndrome

Henrietta S Bada; Thitinart Sithisarn; Julia Gibson; Karen Garlitz; Rhonda Caldwell; Gilson Capilouto; Yinglei Li; Markos Leggas; Patrick Breheny

doi:10.1542/peds.2014-2377

Back

Morphine versus clonidine for neonatal abstinence syndrome

Journal article

Peer reviewed

Morphine versus clonidine for neonatal abstinence syndrome

Henrietta S Bada, Thitinart Sithisarn, Julia Gibson, Karen Garlitz, Rhonda Caldwell, Gilson Capilouto, Yinglei Li, Markos Leggas and Patrick Breheny

Pediatrics (Evanston), Vol.135(2), pp.e383-e391

02/2015

DOI: 10.1542/peds.2014-2377

PMID: 25624389

View Online

Abstract

The study goal was to determine whether clonidine treatment of neonatal abstinence syndrome (NAS) would result in a better neurobehavioral performance compared with morphine. This pilot study prospectively enrolled infants ≥ 35 weeks' gestational age admitted for treatment of NAS. After informed consent was obtained, infants were randomized to receive morphine (0.4 mg/kg per day) or clonidine (5 μg/kg per day) divided into 8 doses. A 25% dose escalation every 24 hours was possible per protocol (maximum of 1 mg/kg per day for morphine and 12 μg/kg per day for clonidine). After control of symptoms, the dose was tapered by 10% every other day. Clinical staff monitored infants by using Finnegan scoring. Masked research staff administered the NICU Network Neurobehavioral Scale (NNNS) at 1 week and at 2 to 4 weeks after initiation of treatment and the Bayley Scales III, and Preschool Language Scale IV, at 1-year adjusted age. Analyses included descriptive statistics, repeated measures analysis of variance, and Wilcoxon tests. Infants treated with morphine (n = 15) versus clonidine (n = 16) did not differ in birth weight or age at treatment. Treatment duration was significantly longer for morphine (median 39 days) than for clonidine (median 28 days; P = .02). NNNS summary scores improved significantly with clonidine but not with morphine. On subsequent assessment, those receiving clonidine had lower height of arousal and excitability (P < .05). One-year motor, cognitive, and language scores did not differ between groups. Clonidine may be a favorable alternative to morphine as a single-drug therapy for NAS. A multicenter randomized trial is warranted.

Analgesics - therapeutic use

Double-Blind Method

Drug Administration Schedule

Humans

Male

Clonidine - therapeutic use

Arousal - drug effects

Dose-Response Relationship, Drug

Opioid-Related Disorders - rehabilitation

Neonatal Abstinence Syndrome - rehabilitation

Pilot Projects

Female

Psychomotor Agitation - rehabilitation

Infant, Newborn

Morphine - therapeutic use

Details

Title: Subtitle: Morphine versus clonidine for neonatal abstinence syndrome
Creators: Henrietta S Bada - Departments of Pediatrics, College of Medicine, hbada2@uky.edu
Thitinart Sithisarn - Departments of Pediatrics, College of Medicine
Julia Gibson - Department of Pharmacy, Kentucky Children's Hospital, Lexington, Kentucky; and
Karen Garlitz - Department of Pharmacy, Kentucky Children's Hospital, Lexington, Kentucky; and
Rhonda Caldwell - Departments of Pediatrics, College of Medicine
Gilson Capilouto - Rehabilitation Sciences, College of Health Sciences
Yinglei Li - Statistics, College of Arts and Sciences and
Markos Leggas - Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky
Patrick Breheny - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.135(2), pp.e383-e391
DOI: 10.1542/peds.2014-2377
PMID: 25624389
NLM abbreviation: Pediatrics
ISSN: 1098-4275
eISSN: 1098-4275
Publisher: American Academy of Pediatrics; United States
Language: English
Date published: 02/2015
Academic Unit: Biostatistics
Record Identifier: 9983997367702771

Metrics

41 Record Views

55 Times Cited - Web of Science

See more details