title: Therapy of the neonatal abstinence syndrome with tincture of opium or morphine drops.
abstract: BACKGROUND
  Treating opioid-addicted women with methadone in pregnancy increased the number of newborns suffering from neonatal abstinence syndrome (NAS). High-pitch crying, insomnia, tremor, myoclonic jerks, vomiting, diarrhoea and poor weight gain were reported symptoms, which were evaluated using the Finnegan (F)-score. Earlier phenobarbital or paregoric had been used to suppress symptoms. We surveyed the administration of pure mu-agonist morphine (MO) in comparison to the alcoholic opioid mixture in tincture of opium (TO). Thirty-three newborns were included in the survey, after informed consent by their parents.
  
  
  RESULTS
  NAS started 3-5 days after delivery and lasted for 27 or 30 days (mean) in the TO and MO groups, respectively. In either of the tested parameters, we found no significant differences between the two groups (2P < 0.05). The maximum F-score was similar in both groups, but the dose to suppress NAS was higher in the MO group (0.6-0.5 mg/day; total dose 61.6-42.7 mg of morphine). The duration of the therapy was longer in the MO than in the TO group (37.5-32.4 days). On the other hand the weight gain was better in the MO group than in the TO group (25-19 g/day), but was reduced in both groups compared with healthy newborns.
  
  
  CONCLUSIONS
  Morphine is suitable to treat NAS in a similar manner as tincture of opium, but avoids unwanted effects of the alcoholic extracts with various alkaloids in the tincture of opium and allows better weight gain of the newborns.
authors.affiliation: Children's Hospital, University of Cologne, Joseph Stelzmann Str. 9, Cologne 50931, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Langenfeld
authors.forename: Larissa
authors.initials: L
authors.lastname: Birkenfeld
authors.forename: Peter
authors.initials: P
authors.lastname: Herkenrath
authors.forename: Carsten
authors.initials: C
authors.lastname: Müller
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Martin
authors.initials: M
authors.lastname: Theisohn
mesh_terms: D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008691:Methadone / Q000009:adverse effects*; D009020:Morphine / Q000008:administration & dosage*; D009357:Neonatal Abstinence Syndrome / Q000188:drug therapy* / Q000378:metabolism; D009892:Opium / Q000008:administration & dosage*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects
chemical_list: D009020:Morphine; D009892:Opium; C017652:paregoric; D008691:Methadone