P2.134: Is There a Difference between those who Require Treatment of Neonatal Opioid Withdrawal Syndrome (NOWS) and Those Who Do Not?

Background: Maternal opioid use, exposure of neonates in-utero and NOWS have continued to be a major public health concern in the US. NOWS is a compilation of symptoms, seen in about 80% of the neonates, secondary to the abrupt discontinuation of in-utero exposure to opioids and other substances. Pharmacologic treatment is required when the infant fails to respond to supportive care. Out aim was to compare the characteristics of neonates with NOWS who required pharmacological treatment versus those who did not.

Methods: This is a sub-set analysis of patients who were enrolled in an IRB approved, prospective, non-inferiority, double-blinded, randomized clinical trial (RCT) of clonidine versus morphine sulphate as a primary treatment for NOWS, after parental consent. All patients were ≥35 weeks gestation and were exposed to opioids in-utero. All patients with symptoms of withdrawal initially received non-pharmacologic treatment (No-Tx group), and if they had 3 consecutive scores ≥ 8 on the Modified Finnegan Neonatal Abstinence Scoring Tool (FNOWST), then pharmacological treatment was initiated (Tx group) with either clonidine or morphine. All patients followed the hospital NOWS treatment protocol.

Results: : Of the 353 neonates who were identified via screening using EPIC EHR, 149 signed consent, and 69 (46%) received pharmacological treatment (Tx group). There was no significant difference in gestational age (38.1 vs 38.5 weeks), birth weight (2904 vs 3067 grams), gender (males 55% vs 52%), or race in the Tx and No-Tx groups. Both groups were predominantly Caucasian (63 and 61% respectively). An equal number of neonates exposed to Methadone required treatment (51% vs 49%). However, those patients exposed to Subutex were less likely to require treatment (67% vs 33%, p=0.002) and those exposed to multiple substances were more likely to require treatment (59% vs 41%, p< 0.001). Those in the No-Tx group were more likely to receive some or all breast milk feeding compared to those in the Tx group (49% vs 27%, p=0.002). The average length of stay was 7.2 days for No-Tx vs 24.1 for Tx group, p< 0.001.

Conclusion: There were no demographic differences between patients who required pharmacological treatment versus those who did not. Patients exposed to Subutex in-utero, not exposed to poly-substance, and those who received some breast milk feeds were less likely to require pharmacological treatment.