Disher T, et al. - Researchers compared pharmacological therapies for neonatal abstinence syndrome. Despite considerable limitations, buprenorphine was reported as the optimal treatment for neonatal abstinence treatment, however, testing in a large multisite trial is needed for wide-scale adoption. Morphine (considered as the standard of care in most hospitals) was identified as the lowest-ranked opioid for length of treatment and length of stay.

Methods

• In this systematic review and network meta-analysis of Medline (1946-June 2018), Embase (1974-June 2018), Cochrane CENTRAL (1966-June 2018), Web of Science (1900-June 2018), and ClinicalTrials.gov (June 2018), researchers analyzed randomized clinical trials of pharmacological treatments for neonatal abstinence syndrome alone or in combination with adjuvant treatments.
• Two reviewers (T.D. and C.G.) independently performed abstract, title, and full-text screening.
• Using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)–Network Meta-Analyses guidelines, 2 reviewers (T.D. and C.G.) independently carried out data extraction.
• Using the Cochrane Risk of Bias tool, quality evaluation was done and data pooling was carried out with fixed-effect models as a result of the low number of trials that were included in the analysis.
• They assessed the length of treatment ( primary outcome) as well as the length of stay, need for adjuvant therapy, and adverse events (secondary outcomes).

Results

• They analyzed 18 eligible trials (N = 1072).
• Buprenorphine, clonidine, diluted tincture of opium and clonidine, diluted tincture of opium, morphine, methadone, and phenobarbital, were the treatments that were included in the length of treatment analysis.
• For a reduction in the length of treatment (days: mean difference vs morphine, −12.75 [95% CI, −17.97 to −7.58]; median rank, 1 [3-1]) and length of stay (days: mean difference vs morphine, −11.43 [95% CI, −16.95 to −5.82]; median rank, 1 [3-1]) but not the need for adjuvant treatment (odds ratio vs morphine, 1.23 [95% CI, 0.46-3.44]; median rank, 3 [5-1]), the treatment that was considered optimal was sublingual buprenorphine.
• They also noted that the results were robust to bias but sensitive to imprecision.