Individualized treatment speeds recovery for babies with opioid withdrawal

A major new study shows that individualized treatment for babies born with opioid withdrawal can speed recovery and reduce time spent in the hospital.

The clinical trial led by Lori A. Devlin, professor in the University of Louisville School of Medicine Department of Pediatrics and neonatologist with Norton Children's, found a customized approach to treating babies with opioid withdrawal helps them recover faster than current standardized practices.

The findings were recently published in the Journal of the American Medical Association (JAMA), one of the nation's leading medical journals. More than 100 researchers across the country contributed to the study.

Every year, over 1,000 Kentucky babies are born with neonatal opioid withdrawal syndrome (NOWS). The syndrome can develop when mothers ingest opioids during pregnancy, causing the infant to experience withdrawal symptoms after birth. Those symptoms can include irritability, difficulty with feeding and sleeping concerns.

The study compared two treatments: a fixed medication schedule and a symptom-based approach that adjusts care based on the severity of each infant's symptoms. Results showed babies treated with the symptom-based approach recovered faster.

When this individualized treatment was combined with the Eat, Sleep, Console (ESC) model of care – which includes family involvement, holding and swaddling before prescribing medication – infants with NOWS left the hospital an average of 2.3 days sooner. Notably, 65% of babies treated with this approach did not need scheduled opioid medications and gradual weaning.

These findings confirm that ESC, combined with symptom-based dosing, helps babies recover faster and reduces unnecessary medication exposure. This work represents a true team effort involving researchers, nurses, administrators and families across the nation, including our team at Norton Children's Research Institute and the UofL Department of Pediatrics."

Lori A. Devlin, professor in the University of Louisville School of Medicine Department of Pediatrics and neonatologist with Norton Children's

Nearly two dozen hospitals nationwide participated in the study, including neonatal intensive care units (NICU) at Norton Children's Hospital, Norton Women's & Children's Hospital and UofL Hospital.

The study builds on more than a decade of research aimed at improving care for infants with NOWS. Devlin previously led the ESC-NOW trial that showed using the family-centered ESC approach reduced hospital stays by about a week and decreased the need for medication from 52% to 19%.

"This research is actively changing how babies with NOWS are treated around the world," Devlin said. "Our team is currently conducting another multicenter study to determine the best type of medication for NOWS."

UofL faculty members Sucheta Telang, Scott Duncan and Ryan Smith were co-authors on the study. 

The study was funded by the National Institutes of Health (NIH), with support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH HEAL (Helping to End Addiction Long-term) Initiative.