AbstractObjectivesTo compare clinical outcomes for infants with neonatal opioid withdrawal syndrome (NOWS) treated with buprenorphine or morphine.Study designRetrospective study of infants born ≥35 weeks’ gestation and admitted to the NICU for NOWS treatment between 2011 and 2022. Length of treatment, length of stay in the hospital, and the need for secondary medications were compared between buprenorphine and morphine treated neonates.

摘要目的比较丁丙诺啡或吗啡治疗新生儿阿片类戒断综合征（NOWS）婴儿的临床结果。研究设计对2011年至2022年间出生≥35周并入住NICU接受NOWS治疗的婴儿进行回顾性研究。比较丁丙诺啡和吗啡治疗的新生儿的治疗时间，住院时间以及对二级药物的需求。

Multiple regression analysis was performed, adjusting for baseline differences and confounders.Results417 neonates were treated with morphine and 232 with buprenorphine. The buprenorphine group had shorter treatment days [−10.8 days; 95% CI: −8.08 to −13.53] and shorter hospital stay [−11.8 days; 95% CI: −8.83 to −14.78].

进行多元回归分析，调整基线差异和混杂因素。结果417例新生儿接受吗啡治疗，232例接受丁丙诺啡治疗。丁丙诺啡组的治疗天数较短[-10.8天；95%CI:-8.08至-13.53]，住院时间较短[-11.8天；95%CI:-8.83至-14.78]。

The buprenorphine group was no more likely to receive phenobarbital or clonidine (26% vs. 29%).ConclusionIn this large single-center study, buprenorphine was associated with shorter lengths of treatment and hospital stay in the treatment of NOWS compared to morphine..

丁丙诺啡组不太可能接受苯巴比妥或可乐定（26%比29%）。结论在这项大型单中心研究中，与吗啡相比，丁丙诺啡治疗NOWS的治疗时间和住院时间更短。。

BackgroundNeonatal opioid withdrawal syndrome (NOWS) is seen in infants with in-utero exposure to opioids who demonstrate at least 2 of 5 signs: excessive crying, fragmented sleep, tremors, increased muscle tone, and/or gastrointestinal dysfunction [1]. The incidence of NOWS has risen over the past few decades, mirroring the opioid epidemic’s escalation [2, 3].

背景新生儿阿片类药物戒断综合征（NOWS）见于子宫内暴露于阿片类药物的婴儿，这些婴儿表现出5种症状中的至少2种：过度哭泣，睡眠破碎，震颤，肌肉张力增加和/或胃肠功能障碍。在过去的几十年中，NOWS的发病率有所上升，反映了阿片类药物疫情的升级[2，3]。

NOWS is associated with significant health care costs, exceeding $2.5 billion annually [4]. These findings underscore the urgent need for effective strategies to prevent and manage NOWS, not only to mitigate the long-term health consequences for affected infants but also to alleviate the financial burden on healthcare systems and society.While non-pharmacological treatment is recommended by AAP as the first-line therapy [5], pharmacological treatment with opioids remains a cornerstone of NOWS management when non-pharmacological measures fail.

NOWS与巨大的医疗保健成本相关，每年超过25亿美元（4）。这些发现强调了迫切需要有效的战略来预防和管理NOWS，不仅要减轻受影响婴儿的长期健康后果，还要减轻医疗保健系统和社会的经济负担。虽然AAP推荐非药物治疗作为一线治疗（5），但当非药物措施失败时，阿片类药物治疗仍然是NOWS管理的基石。

Oral morphine and methadone remain the most prescribed first-line medications for treating NOWS in the United States [6]. However, there has been growing interest in using sublingual buprenorphine as an alternative treatment approach [7, 8]. Buprenorphine has demonstrated improved efficacy compared to other opioids used to treat NOWS in randomized controlled trials [9, 10], retrospective chart reviews [11], and in the context of quality improvement projects [12].

口服吗啡和美沙酮仍然是美国治疗NOWS的处方最多的一线药物（6）。然而，人们越来越有兴趣使用舌下丁丙诺啡作为替代治疗方法[7，8]。在随机对照试验[9，10]，回顾性图表审查[11]和质量改进项目[12]中，丁丙诺啡与其他用于治疗NOWS的阿片类药物相比，疗效有所提高。

The efficacy advantage of buprenorphine has been supported by meta-analysis as well [13]. However, the effects from smaller phase I-III randomized controlled trials (RCTs) [9, 10, 14] and retrospective reviews with varying degrees of adjustment for confounding variables [11, 15] are limited by their sample sizes.Our neonatal intensive care unit (NICU) changed from morphine to buprenorphine as first line therapy in N.

丁丙诺啡的疗效优势也得到了荟萃分析的支持（13）。然而，较小的I-III期随机对照试验（RCT）[9,10,14]和对混杂变量进行不同程度调整的回顾性研究[11,15]的影响受到样本量的限制。我们的新生儿重症监护病房（NICU）从吗啡改为丁丙诺啡作为N的一线治疗。

Data availability

数据可用性

Data will be made available upon reasonable request.

数据将在合理要求下提供。

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Download referencesAuthor informationAuthors and AffiliationsDeparment of Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USASaminathan Anbalagan, Victoria Anderson, Daniela Stark, David Carola, Kolawole Solarin, Susan Adeniyi-Jones & Zubair H. AghaiDeparment of Pediatrics/Neonatology, University of South Alabama, Mobile, AL, USASaminathan AnbalaganDeparment of Pediatrics/Neonatology, ChristianaCare Hospital, Newark, DE, USAMichael T.

下载参考文献作者信息作者和附属机构托马斯·杰斐逊大学/内穆尔，宾夕法尼亚州费城，USASaminathan Anbalagan，维多利亚·安德森，丹妮拉·斯塔克，大卫·卡罗拉，科拉沃尔·索拉林，苏珊·阿德尼伊·琼斯和祖拜尔·H·阿加伊南阿拉巴马大学儿科/新生儿学系，美国阿拉巴马州莫比尔，USASaminathan Anbalagan儿科/新生儿学系，克里斯蒂安那护理医院，纽瓦克，DE，USAMACHAEL T。

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PubMed Google ScholarContributionsSA: Conceptualization, acquisition, analysis, and interpretation of data, drafting the initial and final manuscript and reviewing it for critical content. VA, MTF, DS: Acquisition and analysis of the data and reviewing the final manuscript for critical content.

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Additional informationPublisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Supplementary informationFigure S1. Institutional protocol for management of pharmacotherapy for NOWS using buprenorphine.Figure S2. Institutional protocol for management of pharmacotherapy for NOWS using morphine.Rights and permissions.

Additional informationPublisher的注释Springer Nature在已发布地图和机构隶属关系中的管辖权主张方面保持中立。补充信息图S1。使用丁丙诺啡管理NOWS药物治疗的机构协议。图S2。使用吗啡管理NOWS药物治疗的机构协议。权限和权限。

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Reprints and permissionsAbout this articleCite this articleAnbalagan, S., Anderson, V., Favara, M.T. et al. Buprenorphine vs. morphine: impact on neonatal opioid withdrawal syndrome (NOWS) outcomes in a single center retrospective study.

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J Perinatol (2024). https://doi.org/10.1038/s41372-024-02046-7Download citationReceived: 05 February 2024Revised: 27 June 2024Accepted: 02 July 2024Published: 13 July 2024DOI: https://doi.org/10.1038/s41372-024-02046-7Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

J Perinatol（2024）。https://doi.org/10.1038/s41372-024-02046-7Download引文收到日期：2024年2月5日修订日期：2024年6月27日接受日期：2024年7月2日发布日期：2024年7月13日OI：https://doi.org/10.1038/s41372-024-02046-7Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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