Trial Outcomes & Findings for Morphine Versus Methadone for Opiate Exposed Infants With Neonatal Abstinence Syndrome (NCT NCT02851303)

NCT ID: NCT02851303

Last Updated: 2023-05-24

Results Overview

Number of days in hospital after birth

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

61 participants

Primary outcome timeframe

assessed at hospital discharge, approximately 7-30 days

Results posted on

2023-05-24

Participant Flow

Participants were enrolled as dyads during the initial birth hospitalization. Randomization occured at the time of consent to allow for pharmacologic treatment to begin whenever it was deemed medically necessary without the time constraint of needing randomization by the research team. As not all infants required pharmacologic treatment for withdrawal, they dropped out of the study arm.

Participant milestones

Participant milestones
Measure
Morphine
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Overall Study
STARTED
15
13
Overall Study
COMPLETED
15
13
Overall Study
NOT COMPLETED
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Morphine Versus Methadone for Opiate Exposed Infants With Neonatal Abstinence Syndrome

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Morphine
n=15 Participants
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
n=13 Participants
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Total
n=28 Participants
Total of all reporting groups
Age, Continuous
37.7 weeks
STANDARD_DEVIATION 1.7 • n=5 Participants
37.5 weeks
STANDARD_DEVIATION 1.2 • n=7 Participants
37.6 weeks
STANDARD_DEVIATION 1.5 • n=5 Participants
Age, Customized
Mean age
27.8 years
STANDARD_DEVIATION 4.3 • n=5 Participants
25.4 years
STANDARD_DEVIATION 3.1 • n=7 Participants
26.68 years
STANDARD_DEVIATION 3.9 • n=5 Participants
Sex: Female, Male
Female
15 Participants
n=5 Participants
13 Participants
n=7 Participants
28 Participants
n=5 Participants
Sex: Female, Male
Male
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race/Ethnicity, Customized
White non-hispanic
2 Participants
n=5 Participants
6 Participants
n=7 Participants
8 Participants
n=5 Participants
Race/Ethnicity, Customized
hispanic
11 Participants
n=5 Participants
7 Participants
n=7 Participants
18 Participants
n=5 Participants
Race/Ethnicity, Customized
native american
2 Participants
n=5 Participants
0 Participants
n=7 Participants
2 Participants
n=5 Participants
Initiation of prenatal care in first trimester
5 Participants
n=5 Participants
9 Participants
n=7 Participants
14 Participants
n=5 Participants
Concurrent illicit opioid use
12 Participants
n=5 Participants
10 Participants
n=7 Participants
22 Participants
n=5 Participants
Concurrent tobacco use
9 Participants
n=5 Participants
6 Participants
n=7 Participants
15 Participants
n=5 Participants
Concurrent methamphetamine use
10 Participants
n=5 Participants
2 Participants
n=7 Participants
12 Participants
n=5 Participants
Concurrent benzodiazepine use
4 Participants
n=5 Participants
0 Participants
n=7 Participants
4 Participants
n=5 Participants
Concurrent alcohol use
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Concurrent SSRI
2 Participants
n=5 Participants
0 Participants
n=7 Participants
2 Participants
n=5 Participants
Preterm delivery
4 Participants
n=5 Participants
2 Participants
n=7 Participants
6 Participants
n=5 Participants
Maternal gestational diabetes
1 Participants
n=5 Participants
0 Participants
n=7 Participants
1 Participants
n=5 Participants
Maternal preeclampsia
1 Participants
n=5 Participants
2 Participants
n=7 Participants
3 Participants
n=5 Participants

PRIMARY outcome

Timeframe: assessed at hospital discharge, approximately 7-30 days

Number of days in hospital after birth

Outcome measures

Outcome measures
Measure
Morphine
n=15 Participants
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
n=13 Participants
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Length of Hospital Stay
17.9 days
Standard Deviation 8.6
16.1 days
Standard Deviation 4.7

SECONDARY outcome

Timeframe: assessed at hospital discharge, approximately 7-30 days

Outcome measures

Outcome measures
Measure
Morphine
n=15 Participants
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
n=13 Participants
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Length of Treatment
14.7 days
Standard Deviation 9.9
12.8 days
Standard Deviation 5.8

SECONDARY outcome

Timeframe: assessed at hospital discharge, approximately 7-30 days

clonidine

Outcome measures

Outcome measures
Measure
Morphine
n=15 Participants
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
n=13 Participants
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Need for Additional Agent to Treat Withdrawal, Determined by Chart Review of Medication Administration Record of Administered Medications for Withdrawal Treatment (Example: Clonidine or Phenobarbital)
1 Participants
0 Participants

SECONDARY outcome

Timeframe: assessed at hospital discharge, approximately 7-30 days

Outcome measures

Outcome measures
Measure
Morphine
n=15 Participants
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
n=13 Participants
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Need for Feeding Assistance, Determined by Chart Review of Discharge Summary, Specifically Evaluating for Need for Nasogastric Tube Placement or Peripheral Parenteral Nutrition.
11 Participants
6 Participants

SECONDARY outcome

Timeframe: assessed at hospital discharge, approximately 7-30 days

Outcome measures

Outcome measures
Measure
Morphine
n=15 Participants
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
n=13 Participants
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Need for NICU Transfer, as Determined by Chart Review of Discharge Summary.
0 Participants
3 Participants

SECONDARY outcome

Timeframe: assessed at hospital discharge, approximately 7-30 days

Assessed through chart review of discharge summary documentation of method of infant feeding at time of discharge

Outcome measures

Outcome measures
Measure
Morphine
n=15 Participants
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
n=13 Participants
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Breastfeeding Initiation and Continuation at Hospital Discharge
5 Participants
5 Participants

SECONDARY outcome

Timeframe: assessed at hospital discharge, approximately 7-30 days

Outcome measures

Outcome measures
Measure
Morphine
n=15 Participants
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description
Methadone
n=13 Participants
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description
Total Morphine Equivalent Dose Received
9.86 morphine equivalents mg
Standard Deviation 12.92
33.0 morphine equivalents mg
Standard Deviation 17.49

Adverse Events

Morphine

Serious events: 0 serious events
Other events: 0 other events
Deaths: 0 deaths

Methadone

Serious events: 0 serious events
Other events: 3 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Morphine
n=15 participants at risk
Dose given q 3 - 4 hrs with feeds; do not exceed 4 hrs between doses Morphine (0.04mg/0.1ml) Score Dose For Initiation 0-8 0 None 9-12 0.04 mg/dose 13-16 0.08 mg/dose 17-20 0.12 mg/dose 21-24 0.16 mg/dose 25 or above 0.20mg/dose Morphine Maintenance/Escalation * Maintain dose if score 0-8 * Increase dose by 0.02 if score is 9-12 (rescore before dosing) • Increase dose by 0.04 if score 13-16 * Increase score by 0.06 if score 17-20 Weaning Instructions: * Maintain on dose 48 hrs before starting weaning * Wean 0.02 mg morphine every day for a score is 0-8 • Defer wean for score 9-12 Re-escalation * If neonate scores 9-12 re-score as described for initiation, * If second score is in 9-12 increase morphine 0.01 mg q3-4 hrs • If 2 consecutive scores 13-16, increase 0.02 mg q3-4 hrs * If 2 consecutive scores in 17-20, increase 0.04 mg q3-4 hrs etc Morphine: Morphine wean protocol as described in arm description Adverse events were recorded only for infants of each dyad.
Methadone
n=13 participants at risk
Step 1: 0.7 mgs/Kg/24 hrs. divided by into six doses (q 4 hrs) is starting dose Step 2: Decrease dose by half, which is 50% of starting dose, EVERY 4 hours. Step 3: Same dose which is 50% of starting dose EVERY 6 hours. Step 4: Same dose which is 50% of starting dose EVERY 8 hours. Step 5: Same dose which is 50% of starting dose EVERY 12 hours. Step 6: Decrease dose by half, which is 25% of starting dose EVERY 12 hours. Step 7: Same dose which is 25% of starting dose q 24 hours Methadone: Methadone wean protocol as described in arm description Adverse events were recorded only for infants of each dyad.
Pregnancy, puerperium and perinatal conditions
High level of care transfer
0.00%
0/15 • Collected during initial hospitalization following birth for entire length of hospital stay on infants of dyads only. No infant adverse events following hospital discharge were collected. No maternal adverse events were examined/collected.
23.1%
3/13 • Number of events 3 • Collected during initial hospitalization following birth for entire length of hospital stay on infants of dyads only. No infant adverse events following hospital discharge were collected. No maternal adverse events were examined/collected.

Additional Information

Dr. Mary Beth Sutter

Brown Family Medicine

Phone: 401-921-7981

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place