Comparison of outcomes between morphine and concomitant morphine and clonidine treatments for neonatal abstinence syndrome

Abstract

Aim: To examine whether adding clonidine to the morphine regimen for treatment of neonatal abstinence syndrome (NAS) is associated with a shorter length of treatment compared with morphine alone.

Methods: Using a retrospective cohort design, infants with NAS resulting from opioid exposure delivered between 2006 and 2015 (n = 174) were identified using the Nova Scotia Atlee Perinatal Database (NSAPD). Maternal and infant characteristics were collected from the NSAPD. The database was augmented with chart review for treatment information.

Results: The incidence of NAS in the study population increased fivefold from 1.48/1000 live births in 2007 to 7.50/1000 live births in 2015. Of the 174 infants, 22 were treated with morphine and 100 were treated with morphine + clonidine. Longer length of treatment (p = 0.004) and higher peak morphine dose (p = 0.045) were observed in the combination group.

Conclusion: The increase in the incidence of NAS is consistent with recent published reports. The increase in length of treatment and peak morphine dose in the morphine + clonidine group is in marked contrast to previous work on this treatment combination. Further study on the impact of clinical characteristics such as methadone and antidepressant exposure on the association is warranted.

Keywords: Clonidine; Morphine; Neonatal abstinence syndrome; Opioids.