Pharmacological treatment for neonatal abstinence syndrome

A Cochrane systematic review with meta-analysis (Zankl et al., 2021, studies= 16, N= 1 110) investigated the efficacy and safety of using an opioid as compared to a sedative or non-pharmacological treatment for the treatment of neonatal abstinence syndrome (NAS) due to withdrawal from opioids. The results found:

• moderate quality evidence that treatment failure is reduced by the use of an opioid compared to the use of the sedatives phenobarbital (RR 0.51, 95% CI 0.35 to 0.74; 6 studies, 458 infants) or chlorpromazine (RR 0.08, 95% CI 0.01 to 0.62; 1 study, 90 infants). There was little or no difference in treatment failure according to the type of opioid used (morphine, methadone or buprenorphine)
• moderate quality evidence that the use of sublingual buprenorphine reduces duration of treatment (morphine vs bup MD 12.79, 95% CI 7.57 to 18.00; 3 studies, 112 infants) and hospitalisation (morphine vs bup MD 11.45, 95% CI 5.89 to 17.01; 3 studies, 113 infants) compared to the use of morphine 

There is insufficient evidence to determine the effectiveness and safety of non-pharmacological interventions alone compared to non-pharmacological interventions plus a pharmacological agent (drug such as opioid or sedative).