Neonatal Abstinence Syndrome

[Dred Pirate]

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Couple of questions about your protocols.

1. Do you use methadone or morphine first line?
2. If you max out your first line agent, what do you do second/third line? and what are max doses? phenobarb/clonidine, etc?
3. Would you ever use methadone AND morphine at the same time if you max one of them out and have added adjutant agent(s)?
4. What rescue dose do you use if you have already maxed out morphine? (example, maxed at 0.25 mg/kg q 3 - and you need a rescue dose - do you give a full extra dose of 0.25 or do you do half a dose, etc?_

thanks!

 

[KidPharmD]

1. Morphine (I don't know any children's hospital still using methadone for NAS, I am sure there are some but everyone I know uses morphine)
2. Clonidine 2nd line, Phenobarb 3rd line. We almost never need the phenobarb though. Clonidine is 1-3mcg/kg
3. Nope.
4. Rescue dose is always 0.05mg/kg We max morphine at 0.11 mg/kg/dose.

 

[deleted480308]

Couple of questions about your protocols.

1. Do you use methadone or morphine first line?
2. If you max out your first line agent, what do you do second/third line? and what are max doses? phenobarb/clonidine, etc?
3. Would you ever use methadone AND morphine at the same time if you max one of them out and have added adjutant agent(s)?
4. What rescue dose do you use if you have already maxed out morphine? (example, maxed at 0.25 mg/kg q 3 - and you need a rescue dose - do you give a full extra dose of 0.25 or do you do half a dose, etc?_

thanks!

I’m assuming this is after eat/sleep/console?

 

[Dr Wario]

I remember having to compound doses of morphine for neonates during rotations, one of the saddest things I have ever seen.

 

[KidPharmD]

I’m assuming this is after eat/sleep/console?

For most places, if their Finnegan score is above the 24 rule (above 8 x3 or above 12x2) then they will start pharmacologic intervention in addition to non-pharm measures.

 

[disgonbgud]

Seconding morphine only as our institutional standard (>60 bed NICU), never methadone. Phenobarb supplemental once Finnegan scores remain high after two escalations.
0.05mg/kg/dose is our starting dose when morphine is required. Each escalation is 0.02mg/kg/dose, so effectively, phenobarb starting after >0.1 mg/kg/dose.