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Adjunctive therapy for neonatal abstinence syndrome: Why not personalize it for each infant based on their in-utero exposure?

Journal of Perinatology volume 34, pages 575–576 (2014)Cite this article

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We thank Dr Coyle1 for her insightful critique of our paper and would like to address some of the questions raised. A clarification is however needed as an important first step, as nowhere has a claim been made about the superiority of one drug over the other. The study results have been very clearly stated as follows: shorter inpatient but longer outpatient days with phenobarbital as compared to clonidine; no difference in the total neonatal morphine sulfate (NMS) dosage for the two groups despite longer inpatient days with clonidine; non-significant treatment failures with clonidine; and likewise non-significant adverse effects with phenobarbital. The conclusion was that clonidine is a safe and efficacious alternative adjunct to NMS as compared to phenobarbital.

The study was not designed for total length of treatment (inpatient and outpatient) as that would have been biased towards the clonidine arm, where active inpatient weaning was done. Dr Coyle in her previous work, with rigorous outpatient follow-up, has already shown an average outpatient therapy time of 3.5 months.2 The wide variation of 1–8 months of outpatient therapy by different providers helped us identify an area of improvement and the new clinical guidelines now have a well-defined outpatient weaning protocol for phenobarbital developed by the pediatric pharmacist (see Supplementary Appendix 1 to our paper).

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Baystate Children’s Hospital, Springfield, MA, USA

    R Singh

  2. Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA

    R Singh

  3. Department of Epidemiology, Baystate Medical Center, Springfield, MA, USA

    P F Visintainer

  4. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

    P F Visintainer

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  1. R Singh
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  2. P F Visintainer
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Correspondence to R Singh.

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Singh, R., Visintainer, P. Adjunctive therapy for neonatal abstinence syndrome: Why not personalize it for each infant based on their in-utero exposure?. J Perinatol 34, 575–576 (2014). https://doi.org/10.1038/jp.2014.99

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