1646 Use of Adjunct Clonidine with Phenobarbital Treatment for Neonatal Abstinence Syndrome

Abstract

Background Neonatal abstinence syndrome (NAS) is a complex of symptoms in newborns exposed to substances/drugs in-utero or after birth. Clonidine is a central alpha-2 agonist and recent studies have shown it can decrease NAS symptoms in opiate withdrawal. Objective To determine the efficacy of clonidine as an adjunctive agent to phenobarbitale (PB). To elucidate demographic factors, maternal drug profile, nature of the symptoms in infants. To compare NAS profile with PB and PB+clonidine. To show associated side effects with clonidine. Design/Methods Retrospective review of infants >= 35 weeks GA admitted to HSC, Winnipeg from January 2005 to July 2010. Abstinence scores 20 hours before and 40 hours after PB and PB+clonidine were measured by Finnegan scoring system and compared by ANOVA. Results Twenty four infants (GA 39.3+/-1.4 wks, BW 3316+/-595g) were treated by PB+clonidine combination. Fifty eight percent exposed to multiple drugs. Methadone was the most common drug of exposure. Tremor, increased tone, regurgitation and poor feeding were common symptoms. When PB was used alone as initial therapy, NAS scores increased from 6.9+/-3.3 to 7.5+/-3.0 (p>0.05) at pre and post medication periods respectively. Clonidine was added to PB at 3.5 to 5.3 mg/kg/day and NAS scores were decreased from 8.7+/-3.4 to 7+/-3.5 (p<0.001). There were no recorded side effects for clonidine. Conclusions Our study suggests that clonidine may be a useful adjunctive treatment of NAS in infants who respond incompletely to PB. Cardiovascular side effects were not common in our study.