Maternal drug use and the effectiveness of pharmacotherapy for neonatal abstinence

Abstract

Infants undergoing neonatal abstinence due to maternal drug use have been commonly treated with paregoric, phenobarbital or diazepam. This study was designed to test the effectiveness of each of these agents in the control of abstinence symptomatology. The relationship of the type of maternal drug use to the effectiveness of the treatment was also examined. The subjects included 134 infants born at Thomas Jefferson University Hospital who were treated for abstinence after careful assessment with a scoring system. Infants with serious medical complications were finally eliminated from the study. A series of least squares linear regression analyses was performed using the treatment drug, type of maternal drug (opiates, non-opiates, or both), and the interaction of treatment and maternal drugs as predictors of whether or not a second pharmacotherapeutic agent was needed in order to control abstinence symptomatology. Treatment was considered effective if control was obtained by the use of a single agent. Results revealed that if maternal drug use was limited to non-opiates, phenobarbital therapy was a significant predictor of successful treatment. Treating an infant with diazepam, however, significantly predicted the need for a second agent, regardless of maternal drug use. Paregoric was a significant predictor of successful treatment if maternal drug included opiates or a combination of opiates and other drugs. However, paregoric was also a significant predictor of unsuccessful treatment if the mother abused only non-opiates. Conclusions of the data are as follows: an abstinence scoring system is essential in the assessment of any infant undergoing abstinence, evaluation of the drugs used prenatally will permit more specific drug choices for treating neonatal abstinence, combining a scoring system with specific drug recommendations provides a more objective method of management, paregoric is most efficacious if the infant has prenatal exposure to opiates or a combination of opiates and other agents, phenobarbital is most efficacious if the infant is prenatally exposed to non-opiates only and finally, diazepam is not an appropriate drug for neonatal abstinence either from prenatal exposure to opiates only, opiates and non-opiates or non-opiates only.