Morphine versus methadone for neonatal opioid withdrawal syndrome: a randomized controlled pilot study

Area of Science:

• Neonatalogy
• Pharmacology
• Public Health

Background:

• Neonatal Opioid Withdrawal Syndrome (NOWS) affects millions of neonates annually.
• Optimal pharmacologic weaning protocols for NOWS remain undetermined.
• This study compares morphine and methadone for NOWS treatment.

Purpose of the Study:

• To compare hospital length of stay (LOS) and length of treatment (LOT) for NOWS using morphine versus methadone.
• To evaluate the efficacy and safety of morphine versus methadone in treating neonatal opioid withdrawal.

Main Methods:

• A single-site, open-label, randomized controlled pilot study.
• Infants with primary in-utero opioid exposure (heroin, oral opioids, methadone) born at >= 34 weeks gestation were enrolled.
• Infants were randomized to receive either morphine or methadone for NOWS treatment.

Main Results:

• Sixty-one infants were enrolled; 30 received methadone, 31 received morphine.
• No significant differences in LOS (16.1 vs. 17.9 days) or LOT (12.8 vs. 14.7 days) were observed between methadone and morphine groups.
• Infants treated with methadone received significantly higher total opioid doses (morphine equivalents) and experienced more transfers to the NICU due to over-sedation.

Conclusions:

• Morphine and methadone did not show significant differences in LOS or LOT for NOWS treatment in this pilot study.
• Methadone treatment was associated with higher opioid equivalent dosing and increased NICU transfers for over-sedation compared to morphine.