Comparative effectiveness of opioid replacement agents for neonatal opioid withdrawal syndrome: a systematic review and meta-analysis.

Objective(s): To compare short-term treatment outcomes of opioid pharmacotherapy for neonatal opioid withdrawal syndrome (NOWS).

Study Design: PubMed/MEDLINE, Embase, PsycINFO, and The Cochrane Library were searched from inception through September 30, 2018. Primary outcome was treatment duration (LOT). Secondary outcomes included hospitalization duration (LOS) and rate of adjunct drug needed (RAD).

Results: Of 753 publications, 11 studies met inclusion criteria. There was no difference in LOT (WMD -1.39 [-5.79 to -3.01] days, I 82%) or LOS (WMD -1.48 [-5.75 to -2.79] days, I 92%) between morphine and methadone. RAD with morphine was higher (RR 1.51 [1.35-1.69], I 0%). Buprenorphine was associated with shorter LOT (WMD 7.70 [0.88-14.53] days, I 76%) and LOS (WMD 5.61 [-0.01 to -11.24] days, I 60%) compared with morphine, in addition to methadone according to two cohort studies.

Conclusions: Methadone had superior primary treatment success compared with morphine. Buprenorphine was associated with the shortest overall durations of treatment and hospitalization.