Drugs Should Not Be First Choice For Treating Neonatal Opioid Withdrawal Syndrome: Study

As opioid addictions continue be a major problem throughout the U.S., leading to a corresponding increase in newborns diagnosed with Neonatal Opioid Withdrawal Syndrome (NOWS), a new study advocates against using medications as the first line of treatment for newborns with the dangerous condition.

Neonatal Opioid Withdrawal Syndrome (NOWS) occurs in newborns who were exposed to powerful and addictive pain medications while in the womb, causing infants to experience severe withdrawal symptoms after birth, since they no longer receiving the opioid drugs that were present in their mother’s bloodstream during pregnancy.

Also referred to as newborn opioid addictions or neonatal abstinence syndrome, this condition manifests when a baby’s body attempts to adapt to the sudden absence of opioids, impacting the nervous system and other bodily functions. The severity and duration of the opioid withdrawal syndrome can vary, with symptoms typically emerging within a few days after birth, which can include tremors, excessive crying, sleep disturbances, feeding difficulties, and in severe cases, seizures.

Prior research has highlighted the devastating and long-term side effects infants may experience from the condition, with many children experiencing developmental delays and difficulty with cognitive, social, and motor skills; they also have a higher risk of death.

While there are several pharmaceutical drugs that have been used to treat newborns with opioid withdrawal symptoms, such as morphine and methadone, experts are now advising against the use of these medications as the first line of treatment, due to the potential risk of additional health complications in newborns, as well as increasing evidence about the effectiveness of non-pharmacological interventions.

The American Academy of Pediatrics updated its guidelines in 2020, advocating for non-pharmacologic treatments as the initial approach for managing NOWS, and recommending that medication should only be used as a first line treatment when absolutely necessary for cases involving severe withdrawal symptoms.

Effectiveness of Non-Pharmacological Approaches in Treating NOWS

In a recent study featured in the July 2024 issue of the American Academy of Pediatrics (AAP), researchers explored the impact of the AAP’s 2020 guidelines on the treatment of newborns with opioid withdrawal symptoms; focusing on the overall length of hospital stays, the utilization of neonatal intensive care units (NICUs), and the reliance on pharmacotherapy in managing infants with NOWS.

Phillip D. Hahn suggests that the AAP’s 2020 guidelines, which recommend non-drug treatments, may be more advantageous, especially in reducing the need for neonatal intensive care unit (NICU) admissions. Hahn’s research analyzed data from the 24 months before and after the guidelines were released, from January 2019 to December 2020 and from January 2021 to December 2022, respectively. This analysis employed an interrupted time series approach to track changes in hospital stay lengths, NICU usage, and pharmacotherapy.

The study found that the average length of hospital stays remained largely unchanged before and after the guidelines were implemented. However, NICU admissions decreased significantly, from nearly 80% before the guidelines to about 47% afterward. Additionally, most hospitals reported a reduction in the use of pharmacotherapy.

Hahn and his colleagues concluded that reducing NICU reliance is a crucial step in improving outcomes for infants with NOWS, supporting better parental bonding and breastfeeding by keeping mothers and babies together. They also determined that the effect of AAP’s guidelines was considerable and that it represents a call to action for doctors to align care with AAP guidelines.

The study reinforcing the AAP’s update guidelines support a history of prenatal opioid exposure risks outlined in prior research. Earlier this year in January, a study published in JAMA Network Open found that exposure to opioid medication during pregnancy may increase infant infection risks and other health conditions, both before and after they are born.

Another more recent study published in the medical journal The BMJ, researchers found that a child’s opioid exposure during pregnancy could increase the risk of neuropsychiatric disorders such as epilepsy, depressive disorders, attention deficit hyperactivity disorder (ADHD), mood disorders, and other conditions.