title: The relationship between maternal opioid agonists and psychiatric medications on length of hospitalization for neonatal abstinence syndrome.
abstract: To examine the relationship between maternal opioid agonists, methadone, or buprenorphine (BPH), and concurrent psychiatric medication use on length of hospitalization (LOS) among infants with neonatal abstinence syndrome (NAS).
  
  
  
  We reviewed the charts of infants born at Boston Medical Center between 2003 and 2009 with a diagnosis of NAS whose mothers were prescribed methadone or BPH for opiate addiction. Univariate and multivariate linear regression analyses were used to examine associations between maternal opioid substitution concurrent with psychiatric medication use and infant LOS. We also tested whether exposure to BPH was associated with a shorter hospitalization.
  
  
  
  A total of 273 mother-infant pairs were identified. The average LOS for all infants was 22.9 days (SD: 10.9). In bivariate analyses, maternal use of any psychiatric medication was associated with a longer infant LOS (P < 0.005). Compared with those prescribed methadone alone (n = 158), those also taking benzodiazepines (n = 56) had a 5.88-day longer LOS (95% confidence interval [CI]: 2.15-9.60, P = 0.002). Infants of mothers taking methadone plus an selective serotonin re-uptake inhibitor (n = 51) had a longer LOS (β = 4.47, 95% CI: 1.15-7.79) compared to methadone alone; results remained significant in an initial multivariate model, however the effect was attenuated when additional psychiatric medication use was added to the model. Compared with those exposed to methadone, those exposed to BPH (n = 22) had a significantly shorter LOS (ß = -7.35, CI: -0.18 to -14.52, P = 0.04).
  
  
  
  Maternal use of prescribed methadone and benzodiazepines, compared to methadone alone, increased LOS for infants with NAS by 6 days. Maternal use of BPH was associated with a shorter LOS.
authors.affiliation: Boston Combined Residency Program in Pediatrics, Children's Hospital Boston/Boston Medical Center, MA, USA. ewachman@tuftsmedicalcenter.org
authors.forename: Elisha M
authors.initials: EM
authors.lastname: Wachman
authors.forename: P K
authors.initials: PK
authors.lastname: Newby
authors.forename: Joy
authors.initials: J
authors.lastname: Vreeland
authors.forename: John
authors.initials: J
authors.lastname: Byun
authors.forename: Anthony
authors.initials: A
authors.lastname: Bonzagni
authors.forename: Howard
authors.initials: H
authors.lastname: Bauchner
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Philipp
mesh_terms: D001900:Boston; D002047:Buprenorphine / Q000008:administration & dosage / Q000633:toxicity*; D003430:Cross-Sectional Studies; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000633:toxicity*; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology* / Q000209:etiology; D058850:Opiate Substitution Treatment / Q000009:adverse effects* / Q000706:statistics & numerical data*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000633:toxicity*; D012307:Risk Factors
chemical_list: D011619:Psychotropic Drugs; D002047:Buprenorphine; D008691:Methadone