Clonidine, a non-opioid approved for the treatment of hypertension, may be an effective alternative to morphine for neonatal opioid withdrawal syndrome (NOWS), according to a report in Pediatrics.
Babies who are exposed to opioids in the womb can develop significant withdrawal symptoms after birth. “Despite the detrimental effects of in utero opioid exposure, the opiate morphine remains a common first-line drug for NOWS treatment, resulting in additional weeks to months of exposing the developing brain to opioids,” wrote Henrietta Bada, M.D., M.P.H., of the University of Kentucky, and colleagues.
Between December 2017 and February 2022, Bada and colleagues randomized 120 infants with NOWS to receive either oral clonidine at 1 µg/kg/dose or morphine at 60 µg/kg/dose, every three hours. Infants with no improvement had their doses increased by 25% every 12 to 24 hours, up to a maximum of 2 μg/kg/dose for clonidine and 120 µg/kg/dose for morphine. Those without improvement by the maximum dose received an adjunct medication such as phenobarbital. Once withdrawal symptoms stabilized, medication doses were weaned by 10% every 24 hours.
All infants also had non-pharmacological interventions including swaddling, low noise and lighting environment, infant massage, and maternal rooming with the infant.
Primary outcomes were length of treatment and neurobehavioral performance as measured by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS).
Neither length of treatment nor length of hospital stay differed significantly between the two groups. Clonidine treatment lasted between 15 to 19 days while morphine treatment lasted 13 to 17 days; length of stay was between 20 to 24 days for clonidine and 17 to 20 days for morphine. However, 45% of clonidine-treated infants needed adjunct medication compared with just 10% in the morphine group, a concerning finding that the authors said may be related to the dosing schedule for clonidine.
Clonidine-treated infants performed as well on the NNNS as morphine-treated infants. At the initial testing—conducted as soon as withdrawal symptoms stabilized—clonidine-treated babies scored worse on arousal, hypertonicity, and stress abstinence, but at their following treatment, they showed significant improvement with less handling required, reduced excitability and stress abstinence, and improved arousal and regulation.
“We were able to successfully provide an opioid-sparing, medication-assisted treatment regimen to a cohort of infants with significant NOWS,” Bada and colleagues wrote. “Future studies are needed to investigate the optimal dose and frequency of clonidine administration for improved efficacy and the decreased need for adjunctive therapy in NOWS.”
For related information, see the Psychiatric News article “Neonatal Abstinence Syndrome Linked to Unemployment, Mental Health Shortages.”
(Image: Getty Images/iStock/Orbon Alija)
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