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

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 cloni...

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Published in:Archives of disease in childhood 2012-10, Vol.97 (Suppl 2), p.A465-A466
Main Authors: Soylu, H, Mehrem, A Abou, Baier, RJ
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Infants
Narcotics
Neonates
Side effects
Variance analysis
Young Children
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description 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
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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&gt;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&lt;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.</description><identifier>ISSN: 0003-9888</identifier><identifier>EISSN: 1468-2044</identifier><identifier>DOI: 10.1136/archdischild-2012-302724.1646</identifier><identifier>CODEN: ADCHAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher><subject>Infants ; Narcotics ; Neonates ; Side effects ; Variance analysis ; Young Children</subject><ispartof>Archives of disease in childhood, 2012-10, Vol.97 (Suppl 2), p.A465-A466</ispartof><rights>2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2012 (c) 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1828862655/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1828862655?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21378,21394,27924,27925,33611,33877,43733,43880,74221,74397</link.rule.ids></links><search><creatorcontrib>Soylu, H</creatorcontrib><creatorcontrib>Mehrem, A Abou</creatorcontrib><creatorcontrib>Baier, RJ</creatorcontrib><title>1646 Use of Adjunct Clonidine with Phenobarbital Treatment for Neonatal Abstinence Syndrome</title><title>Archives of disease in childhood</title><addtitle>Arch Dis Child</addtitle><description>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&gt;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&lt;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.</description><subject>Infants</subject><subject>Narcotics</subject><subject>Neonates</subject><subject>Side effects</subject><subject>Variance analysis</subject><subject>Young Children</subject><issn>0003-9888</issn><issn>1468-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>ALSLI</sourceid><sourceid>CJNVE</sourceid><sourceid>M0P</sourceid><recordid>eNqVkE1LJDEQhoMoOH78h4Dssd18dCfpwx6GRldhxhX8QPQQ0ukK0-NM4iY9qP9-0_SyeN1TFcXzVlEPQt8oOaeUi-8m2lXXJ7vqN13BCGUFJ0yy8pyKUuyhGS2FyvOy3EczQggvaqXUITpKaU0yrRSfoZeRxQ8JcHB43q133g642QTfd70H_N4PK3y7Ah9aE9t-MBt8H8EMW_ADdiHiGwjejON5m4ac8Bbw3afvYtjCCTpwZpPg9G89Rg-XF_fNVbH49fO6mS-KlrFSFGBrJypuhe2YraFyUNZdCYI7S2rXyopaCYZLWTPKOsWcZZWgkprcSFMLfozOpr1vMfzeQRr0Ouyizyc1VflNwURVZerHRNkYUorg9FvstyZ-akr06FN_9alHn3ryqUdHOV9M-T4N8PEvbOKrFpLLSt88Nvp22SyfFstnfZV5NfHtdv2fp_4Alr2OaA</recordid><startdate>201210</startdate><enddate>201210</enddate><creator>Soylu, H</creator><creator>Mehrem, A Abou</creator><creator>Baier, RJ</creator><general>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88B</scope><scope>88E</scope><scope>88I</scope><scope>8A4</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>CJNVE</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0P</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEDU</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope></search><sort><creationdate>201210</creationdate><title>1646 Use of Adjunct Clonidine with Phenobarbital Treatment for Neonatal Abstinence Syndrome</title><author>Soylu, H ; 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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. 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Narcotics
Neonates
Side effects
Variance analysis
Young Children
title 1646 Use of Adjunct Clonidine with Phenobarbital Treatment for Neonatal Abstinence Syndrome
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