Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome

Journal of Perinatology volume 31, pages 25–29 (2011)Cite this article

Subjects

Abstract

Objective:

To identify maternal and neonatal factors that impact response to methadone therapy for neonatal abstinence syndrome.

Study Design:

This is a retrospective review of 128 infants that received pharmacotherapy for opiate withdrawal to identify factors associated with favorable response to methadone therapy. Maternal and neonatal data were analyzed with univariate statistics and multivariate logistic regression.

Result:

Maternal methadone maintenance dose during pregnancy correlated with length of stay (P=0.009). There was an inverse correlation between the amount of mother's breast milk ingested and length of stay (β=−0.03, P=0.02). Methadone was initiated later, tapered more rapidly and was more successful as monotherapy in preterm infants. Five percent of infants were admitted to hospital again for rebound withdrawal following reduction of breast milk intake.

Conclusion:

Severity of neonatal abstinence syndrome may be mitigated by titrating methadone to the lowest effective dose during pregnancy and by encouraging breast milk feeds, which should be weaned gradually.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Finnegan LP . Treatment issues for opioid-dependent women during the perinatal period. J Psychoactive Drugs 1991; 23 (2): 191–201.

    Article  CAS  PubMed  Google Scholar 

  2. Jarvis MA, Schnoll SH . Methadone treatment during pregnancy. J Psychoactive Drugs 1994; 26 (2): 155–161.

    Article  CAS  PubMed  Google Scholar 

  3. Hytinantti T, Kahila H, Renlund M, Jarvenpaa AL, Halmesmaki E, Kivitie-Kallio S . Neonatal outcome of 58 infants exposed to maternal buprenorphine in utero. Acta Paediatr 2008; 97 (8): 1040–1044.

    Article  CAS  PubMed  Google Scholar 

  4. Neonatal drug withdrawal. American Academy of Pediatrics Committee on Drugs. Pediatrics 1998; 101 (6): 1079–1088.

    Google Scholar 

  5. Ebner N, Rohrmeister K, Winklbaur B, Baewert A, Jagsch R, Peternell A et al. Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Drug Alcohol Depend 2007; 87 (2–3): 131–138.

    Article  PubMed  Google Scholar 

  6. Oei J, Lui K . Management of the newborn infant affected by maternal opiates and other drugs of dependency. J Paediatr Child Health 2007; 43 (1–2): 9–18.

    Article  PubMed  Google Scholar 

  7. Rosen TS, Pippenger CE . Pharmacologic observations on the neonatal withdrawal syndrome. J Pediatr 1976; 88 (6): 1044–1048.

    Article  CAS  PubMed  Google Scholar 

  8. Kuschel CA, Austerberry L, Cornwell M, Couch R, Rowley RS . Can methadone concentrations predict the severity of withdrawal in infants at risk of neonatal abstinence syndrome? Arch Dis Child Fetal Neonatal Ed 2004; 89 (5): F390–F393.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lainwala S, Brown ER, Weinschenk NP, Blackwell MT, Hagadorn JI . A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care 2005; 5 (5): 265–272.

    Article  PubMed  Google Scholar 

  10. McCarthy JJ, Leamon MH, Parr MS, Anania B . High-dose methadone maintenance in pregnancy: maternal and neonatal outcomes. Am J Obstet Gynecol 2005; 193 (3 Part 1): 606–610.

    Article  CAS  PubMed  Google Scholar 

  11. Dashe JS, Sheffield JS, Olscher DA, Todd SJ, Jackson GL, Wendel GD . Relationship between maternal methadone dosage and neonatal withdrawal. Obstet Gynecol 2002; 100 (6): 1244–1249.

    CAS  PubMed  Google Scholar 

  12. Berghella V, Lim PJ, Hill MK, Cherpes J, Chennat J, Kaltenbach K . Maternal methadone dose and neonatal withdrawal. Am J Obstet Gynecol 2003; 189 (2): 312–317.

    Article  CAS  PubMed  Google Scholar 

  13. Kraft WK, Gibson E, Dysart K, Damle VS, Larusso JL, Greenspan JS et al. Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial. Pediatrics 2008; 122 (3): e601–e607.

    Article  PubMed  Google Scholar 

  14. Choo RE, Huestis MA, Schroeder JR, Shin AS, Jones HE . Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure. Drug Alcohol Depend 2004; 75 (3): 253–260.

    Article  CAS  PubMed  Google Scholar 

  15. Doberczak TM, Kandall SR, Wilets I . Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr 1991; 118 (6): 933–937.

    Article  CAS  PubMed  Google Scholar 

  16. Dysart K, Hsieh HC, Kaltenbach K, Greenspan JS . Sequela of preterm versus term infants born to mothers on a methadone maintenance program: differential course of neonatal abstinence syndrome. J Perinat Med 2007; 35 (4): 344–346.

    Article  CAS  PubMed  Google Scholar 

  17. Ballard JL . Treatment of neonatal abstinence syndrome with breast milk containing methadone. J Perinat Neonatal Nurs 2002; 15 (4): 76–85.

    Article  PubMed  Google Scholar 

  18. Abdel-Latif ME, Pinner J, Clews S, Cooke F, Lui K, Oei J . Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006; 117 (6): e1163–e1169.

    Article  PubMed  Google Scholar 

  19. Begg EJ, Malpas TJ, Hackett LP, Ilett KF . Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing. Br J Clin Pharmacol 2001; 52 (6): 681–685.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Wojnar-Horton RE, Kristensen JH, Yapp P, Ilett KF, Dusci LJ, Hackett LP . Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol 1997; 44 (6): 543–547.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Oei J, Feller JM, Lui K . Coordinated outpatient care of the narcotic-dependent infant. J Paediatr Child Health 2001; 37 (3): 266–270.

    Article  CAS  PubMed  Google Scholar 

  22. Burns L, Mattick RP . Using population data to examine the prevalence and correlates of neonatal abstinence syndrome. Drug Alcohol Rev 2007; 26 (5): 487–492.

    Article  PubMed  Google Scholar 

  23. Abrahams RR, Kelly SA, Payne S, Thiessen PN, Mackintosh J, Janssen PA . Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Can Fam Physician 2007; 53 (10): 1722–1730.

    PubMed  PubMed Central  Google Scholar 

  24. Finnegan LP, Connaughton Jr JF, Kron RE, Emich JP . Neonatal abstinence syndrome: assessment and management. Addict Dis 1975; 2 (1–2): 141–158.

    CAS  PubMed  Google Scholar 

  25. Coyle MG, Ferguson A, Lagasse L, Oh W, Lester B . Diluted tincture of opium (DTO) and phenobarbital versus DTO alone for neonatal opiate withdrawal in term infants. J Pediatr 2002; 140 (5): 561–564.

    Article  CAS  PubMed  Google Scholar 

  26. Jansson LM, Choo R, Velez ML, Harrow C, Schroeder JR, Shakleya DM et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 2008; 121 (1): 106–114.

    Article  PubMed  Google Scholar 

  27. Malpas TJ, Darlow BA . Neonatal abstinence syndrome following abrupt cessation of breastfeeding. NZ Med J 1999; 112 (1080): 12–13.

    CAS  Google Scholar 

Download references

Acknowledgements

We acknowledge the staff of the Department of Pharmacy at The University Hospital for their support, especially Monica Commins, and to Laura Gerlacht, Eric Mueller and Steven Hoath for critical review of the article.

Author information

Authors and Affiliations

  1. Department of Pharmacy, The University Hospital, Cincinnati, OH, USA

    B Isemann

  2. Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

    J Meinzen-Derr

  3. Divisions of Pulmonary Biology and Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

    H Akinbi

  4. Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA

    H Akinbi

Authors
  1. B Isemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J Meinzen-Derr
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H Akinbi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B Isemann.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Isemann, B., Meinzen-Derr, J. & Akinbi, H. Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol 31, 25–29 (2011). https://doi.org/10.1038/jp.2010.66

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2010.66

Keywords

This article is cited by

Search

Advanced search

Quick links