766 - Maternal Methadone and Buprenorphine Dose Does Not Affect Severity of Neonatal Opioid Withdrawal Syndrome in Infants Managed Using Eat, Sleep, Console

Neonatal opioid withdrawal syndrome (NOWS) is a cluster of neurologic, gastrointestinal, and musculoskeletal signs in opioid-exposed neonates. Traditionally, NOWS was managed utilizing the Finnegan Neonatal Abstinence Score System (FNASS). In recent years, the Eat, Sleep, Console (ESC) approach has gained popularity. Prior studies have explored the correlation of methadone and buprenorphine doses with NOWS severity in FNASS-managed infants, with varying results. However, no studies have yet examined the correlation of NOWS severity with maternal methadone and buprenorphine doses in infants with NOWS who were managed with the ESC approach.

Objective:

To assess the correlation between high, medium, and low maternal methadone and buprenorphine doses with the severity of NOWS in infants who were managed using the ESC approach.

Design/Methods:

We retrospectively compared outcomes for 299 buprenorphine- or methadone-exposed infants on our general inpatient unit from February 2013-July 2019 who were managed with the ESC approach. Indicators of NOWS severity (average length of stay (ALOS), peak daily FNASS score, proportion of patients treated pharmacologically, and proportion of feeds via breastfeeding) were compared between infants exposed to high ( >100mg), intermediate (65.5-100mg), and low doses (< 65.5 mg) of methadone or high ( >16mg), intermediate (8-16mg), and low doses (< 8mg) of buprenorphine.

Infants well-managed on ESC were defined as 1) able to eat ³1 oz per feed or breastfeed well; 2) sleep undisturbed for ³1 hour; and 3) to be consoled within 10 minutes when crying. Infants not achieving ³1 of these goals were further optimized using these nonpharmacologic interventions or were started on morphine treatment. Outcome measures were assessed by high- vs intermediate- vs low-dose of methadone or buprenorphine. They were analyzed using negative binomial regression with incidence rate ratios (ALOS, breastfeeding rates), simple logistic regression (morphine administration rates), and linear regression (peak FNASS scores).

Results:

Of infants in our cohort, 248 (83%) were exposed to methadone and 51 (17%) to buprenorphine. There were no differences in ALOS, peak daily FNASS score, morphine administration rates, or breastfeeding rates between high, intermediate, or low doses of maternal methadone and between high, intermediate, or low doses of maternal buprenorphine (Table 1).

Conclusion(s):

Higher maternal opioid doses did not affect the severity of NOWS in infants managed using ESC.