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Does Maternal Buprenorphine Dose Affect Severity or Incidence of Neonatal Abstinence Syndrome?

Wong, Jacqueline, MD; Saver, Barry, MD, MPH; Scanlan, James M., PhD; Gianutsos, Louis Paul, MD, MPH; Bhakta, Yachana, BS; Walsh, James, MD; Plawman, Abigail, MD; Sapienza, David, MD; Rudolf, Vania, MD, MPH

doi: 10.1097/ADM.0000000000000427
Original Research

Objectives: To measure the incidence, onset, duration, and severity of neonatal abstinence syndrome (NAS) in infants born to mothers receiving buprenorphine and to assess the association between buprenorphine dose and NAS outcomes.

Methods: We reviewed charts of all mother–infant pairs maintained on buprenorphine who delivered in our hospital from January 1, 2000 to April 1, 2016.

Results: In 89 infants, NAS incidence requiring morphine was 43.8%. Means for morphine-treated infants included: 55.2 hours to morphine start, 15.9 days on morphine, and 20 days hospital stay. NAS requiring morphine treatment occurred in 48.5% and 41.4% of infants of mothers receiving ≤8 mg/d buprenorphine versus >8 mg/d, respectively (P = 0.39). We found no significant associations of maternal buprenorphine dose with peak NAS score, NAS severity requiring morphine, time to morphine start, peak morphine dose, or days on morphine. Among the other factors examined, only exclusive breastfeeding was significantly associated with neonatal outcomes, specifically lower odds of morphine treatment (odds ratio 0.24, P = 0.003).

Conclusions: These findings suggest higher buprenorphine doses can be prescribed to pregnant women receiving medication therapy for addiction without increasing NAS severity. Our finding of reduced risk of NAS requiring morphine treatment also suggests breastfeeding is both safe and beneficial for these infants and should be encouraged.

Department of Family Medicine, Cherry Hill, Swedish Medical Center, Seattle, WA (JW, BS, LPG, YB); Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, WA (JMS); Addiction Recovery Services, Swedish Medical Center, Seattle, WA (JW, JW, DS, VR); Multicare East Pierce Family Medicine, Puyallup, WA (AP).

Send correspondence to Jacqueline Wong, MD, Department of Family Medicine, Swedish Medical Center Cherry Hill Campus, 550 16th Ave Suite #100, Seattle, WA 98122. E-mail:

Received 31 October, 2017

Accepted 10 May, 2018

© 2018 American Society of Addiction Medicine