Success of A Methadone Treatment Protocol in Neonatal Drug Withdrawal Following in-Utero Exposure to Substances of Abuse

Purpose: To evaluate the effectiveness of a methadone treatment protocol for NAS.

Methods: Neonates who received methadone treatment according to a preexisting treatment protocol were evaluated for treatment success defined as adherence to the methadone regimen with no residual signs of withdrawal. Data collected included: methadone dosages, Lipsitz scores, length of methadone treatment (LOT), and total length of stay (LOS).

Results: Sixty subjects were included. The mean gestational age (GA) and birth weight (BW) were 36.8 + 3.03 weeks and 2.79 + 0.63kg,. All exhibited NAS within 72 hours of life. 59/60 (98.3%) initiated treatment according to protocol. There was significant deviation from the protocol at 48 and 72 hours of treatment with 33% and 12% of the patients requiring more than the prescribed amount of methadone to control NAS. The mean (SD) total methadone exposure was 1.96 + 1.63 mg/kg, LOT 11.66 + 9 days and LOS 22.4 + 29.3 days suggesting significant variability in response. No significant correlation was found between BW or GA and LOT.

Conclusion: At diagnosis a protocol for treating NAS was closely followed. Despite a formal protocol there was substantial variability in total methadone exposure, LOT and LOS suggesting other contributory factors for the observed variability