Antenatal Exposure to Medication for Opioid Use Disorder and Infant Outcomes in the Eat, Sleep, Console for Neonatal Opioid Withdrawal Randomized Controlled Trial.

OBJECTIVE: To evaluate associations between care approach (usual care vs Eat, Sleep, Console [ESC]) on infant outcomes, and how these associations were modified by medication (buprenorphine or methadone) for opioid use disorder (MOUD). STUDY DESIGN: A post hoc, subgroup analysis was conducted on infants with antenatal exposure to MOUD enrolled in Eat, Sleep, Console for Neonatal Opioid Withdrawal (ESC-NOW), a multicenter, stepped-wedge, cluster-randomized controlled trial. RESULTS: There were 949 infants enrolled in the Eat, Sleep, Console for Neonatal Opioid Withdrawal trial and exposed to MOUD (604 buprenorphine, 345 methadone). Infants managed with ESC vs usual care were less likely to receive pharmacologic treatment for NOWS (57.4% vs 18.0%; absolute difference 39.4%; 95% CI: 30.6-48.2; P < .001). Length of hospital stay was 5.4 days shorter (95% CI: 1.9, 8.8; P = .003) in the ESC group. Stratified by MOUD type, infants exposed to methadone managed with ESC had a 9.5 day (95% CI: 4.8-14.2) shorter length of treatment than those managed with usual care (11.1 vs 20.6 days). No significant difference was found between care approaches in length of treatment for buprenorphine-exposed infants (12.3 vs 13.1 days; 95% CI: -4.4 to 6.1). CONCLUSIONS: Use of the ESC care approach was associated with a decrease in pharmacologic treatment for NOWS and a shorter hospital stay for infants with antenatal MOUD exposure. Methadone exposure was associated with a shorter length of pharmacologic treatment for infants cared for with ESC when compared with usual care, whereas such an association was not seen for buprenorphine exposed infants. TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT04057820.

Duke Scholars

Author Rachel Gottron Greenberg Pediatrics, Neonatology

Author Phillip Brian Smith Pediatrics, Neonatology