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Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome


Walter K. Kraft, 132 South 10th Street, 1170 Main Building, Department of Pharmacology and Experimental Therapeutics, Jefferson Medical College, Philadelphia, USA. E-mail:


Aims  More than half of infants exposed to opioids in utero develop neonatal abstinence syndrome (NAS) of severity to require pharmacological therapy. Current treatments are associated with prolonged hospitalization. We sought to optimize the dose of sublingual buprenorphine in the treatment of NAS.

Design  Randomized, Phase 1, open-label, active-control clinical trial comparing sublingual buprenorphine to oral morphine.

Setting  Large, urban, tertiary care hospital.

Participants  Twenty-four term infants requiring pharmacological treatment for NAS.

Measurements  Outcomes were neonatal safety, length of treatment and length of hospitalization.

Findings  Sublingual buprenorphine was safe and effective. Infants treated with buprenorphine had a 23-day length of treatment compared to 38 days for those treated with morphine (P = 0.01), representing a 40% reduction. Length of hospital stay in the buprenorphine group was reduced 24%, from 42 to 32 days (P = 0.05).

Conclusions   Sublingual buprenorphine was safe in NAS, with a substantial efficacy advantage over standard of care therapy with oral morphine.