The purpose of the study is to determine whether buprenorphine is a beneficial, safe, cost effective treatment alternative to morphine sulfate in the treatment of Neonatal Abstinence Syndrome (NAS).
Neonatal abstinence syndrome is a condition that affects newborns who are exposed to chronic opioid drugs while they are in a mother's uterus (womb) prior to birth. The current standard of care treatment includes morphine sulfate. Buprenorphine is a drug used in adults to treat narcotic dependence and withdrawal, but has not yet been approved for use in newborns as a treatment alternative for Neonatal Abstinence Syndrome. This investigation is designed to measure if sublingual (under the tongue) buprenorphine is able to reduce hospital length of stay and decrease number of days of drug treatment currently required in treatment of NAS. Another goal will be to understand buprenorphine as a cost effective treatment for NAS.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
29
The injectable formulation of buprenorphine (Buprenex; Reckitt Benckiser) will be prepared to a final concentration of 0.075 mg/mL in 100% ethanol and simple syrup USP to create a sublingual preparation. Infants initial dose: 15.9 µg/kg per day in 3 divided doses with escalation/weaning based upon standardized scoring of NAS symptoms, using standardized Finnegan scoring Maximum dosage: 60 µg/kg per day Duration: Infants will receive buprenorphine until they are successfully weaned off of opioids and no longer show withdrawal symptoms, evidenced by low Finnegan scores. Mean use in other investigations was 24 days.
Oral Morphine Sulfate Dosage: Morphine Sulfate Oral Solution 100mg/5mL Initially dosed at 0.4mg/kg per day in six daily doses Duration of medication administration dependent upon infant symptoms of neonatal withdrawal, with mean duration of use at Banner Good Samaritan Hospital currently averaging 25 days.
Banner - University Medical Center Phoenix
Phoenix, Arizona, United States
Hospital length of stay
Number of days of hospital admission
Time frame: Up to hospital discharge, an anticipated average of 4 weeks
Number of adverse or serious adverse events
Time frame: Up to hospital discharge, with length of stay currently averaging approximately 4 weeks
Cost efficiency of buprenorphine
Cost of buprenorphine as a product of number of days of administration
Time frame: At least 48 prior to hospital discharge, with anticipated discharge averaging to be 4 weeks
Withdrawal symptoms
Finnegan methodology to score withdrawal symptoms every four hours of medication administration
Time frame: Up to hospital discharge, usually occuring on average 4 weeks
Rescue dosage administration
Number of rescue doses of additional medication
Time frame: Up to hospital discharge, anticipating an average of 4 weeks
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