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Oral Morphine Weaning for Neonatal Abstinence Syndrome at Home Compared with In-Hospital: An Observational Cohort Study

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Abstract

Objective

The objective of this observational study was to evaluate the safety and effectiveness of discharging stabilized neonates to complete their oral morphine weaning at home.

Study Design

This retrospective cohort study evaluated neonates treated with oral morphine at two hospitals in London, Ontario, Canada. Neonates who completed their morphine wean in hospital were compared with neonates who completed their morphine wean following discharge from hospital (at home).

Results

There were 80 neonates treated with oral morphine at two hospitals from 2006 to 2010. The majority (65 %, 52/80) of neonates completed their morphine weaning after hospital discharge and were significantly less likely to return to hospital for further withdrawal treatment (1/52 vs 4/28, p < 0.05). Neonates who were treated at home remained on morphine for more days (32 vs 19 days, p < 0.01).

Conclusions

We present the first North American cohort of neonates weaned with morphine at home for neonatal abstinence syndrome (NAS). We found that more days on oral morphine resulted in fewer returns to hospital for continued withdrawal management. There was no evidence of increased effectiveness, measured by the number of returns to hospital for further NAS management with in-hospital weaning. The estimated cost savings of continued weaning upon discharge was approximately $11,000 per patient (Canadian dollars). While further prospective research is necessary, in some cases morphine weaning at home may present a safe and cost-effective strategy for NAS management.

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Financial Disclosure

The authors of this article declare that they have no financial relationships to disclose pertinent to this article.

Conflict of interest

LE Kelly, D Knoppert, H Roukema, M Rieder and G Koren have no relevant conflicts of interest to declare.

Contributor’s Statement

Lauren Kelly is the first author who designed the study, collected and analyzed the data. David Knoppert was the pharmacy team lead and was responsible for overseeing the morphine-weaning calendars. Dr. Henry Roukema is a neonatologist directly involved in patient care at both centers. Dr. Michael Rieder and Dr. Gideon Koren were responsible for the study design, manuscript revisions and study oversight. All authors critically reviewed the manuscript and approved the final draft for submission.

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Authors and Affiliations

  1. Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Lauren E. Kelly, Michael J. Rieder & Gideon Koren

  2. Ivey Chair in Molecular Toxicology, Western University, London, ON, Canada

    Gideon Koren

  3. Department of Pharmacy Services, London Health Sciences Centre, London, ON, Canada

    David Knoppert

  4. Department of Pediatrics, London Health Sciences Centre, London, ON, Canada

    David Knoppert, Henry Roukema & Michael J. Rieder

  5. Department of Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G 0A4, Canada

    Gideon Koren

Authors
  1. Lauren E. Kelly
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  2. David Knoppert
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  3. Henry Roukema
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  4. Michael J. Rieder
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  5. Gideon Koren
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Corresponding author

Correspondence to Lauren E. Kelly.

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Kelly, L.E., Knoppert, D., Roukema, H. et al. Oral Morphine Weaning for Neonatal Abstinence Syndrome at Home Compared with In-Hospital: An Observational Cohort Study. Pediatr Drugs 17, 151–157 (2015). https://doi.org/10.1007/s40272-014-0096-y

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  • DOI: https://doi.org/10.1007/s40272-014-0096-y

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