Buprenorphine has been used for the treatment of neonatal abstinence since the mid-1990s, principally in France. Two small randomized controlled trials (n=20, 21) (Jones 2005, Fischer 2006) and one large case comparison study (Lejune 2006) have shown the neonatal abstinence syndrome is not more severe than methadone. The pharmacological activity of buprenorphine has been used to suggest that the risk of severe neonatal abstinence syndrome may indeed be less than for neonates exposed to methadone (Jasinski 1977).
A recent Czech open label randomised study (n=147), comparing buprenorphine to methadone and continued heroin use (Binder 2008) has demonstrated vastly reduced risk of neonatal abstinence and reduced length of stay for neonates exposed to buprenorphine compared to methadone.
This finding has important implications if indeed there is a significant difference replicated in other studies.
The John Hunter Hospital has a multidisciplinary clinical team to manage women with high risk pregnancies including opiate use. Standard care is commencement on methadone or continuation of methadone or buprenorphine maintenance. Approximately 60 women with opiate use as a significant risk are referred top the unit each year.
This paper is a retrospective audit of all cases of babies born to pregnant women on buprenorphine or methadone who have been referred to the John Hunter Hospital from 2004/05 to 2007/08. The paper will report on neonatal outcomes including neonatal abstinence, birth weight and adverse events.