title: Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center.
abstract: BACKGROUND
  Exploratory buprenorphine ingestions in young children have been associated with clinically significant toxicity. However, detailed data on the clinical presentation and management of these patients are lacking. In an attempt to obtain more comprehensive data, we sought to examine a single center cohort of patients with report of buprenorphine exposure and provide descriptive analysis of rates of respiratory depression, time to respiratory depression, interventions, disposition, and outcomes.
  
  
  METHODS
  We performed a retrospective cohort study at a single pediatric tertiary care center of children between the age of 6 months and 7 years of age hospitalized between 1 January 2006 and 1 September 2014 with report of buprenorphine or buprenorphine/naloxone exposure. Patients with possible exposure to more than one agent were excluded. We extracted clinical findings, including time to respiratory depression, interventions, and disposition from the medical record.
  
  
  RESULTS
  Eighty-eight patients met the inclusion criteria. Seven patients were excluded. The median age was 24 months [IQR 18-30]. 20 patients (23%) received activated charcoal while 48 (55%) were treated with naloxone. 36 (41%) patients were admitted to the ICU. Observed clinical effects included respiratory depression (83%), oxygen saturation by pulse oximetry (SpO2)< 93% (28%), depressed mental status (80%), miosis (77%), and emesis (45%). Median time from exposure to respiratory depression was 263 min [IQR 105-486]. The median hospital length of stay was 22 h [IQR 20-26] and was positively associated with estimated exposure dose (p = 0.002).
  
  
  CONCLUSIONS
  Pediatric patients exposed to buprenorphine are likely to exhibit signs and symptoms of opioid toxicity, including respiratory depression, altered mental status and miosis. Although the majority of patients developed signs of clinical toxicity within 8 h of reported exposure, the optimum duration of monitoring remains unclear.
authors.affiliation: a Harvard Medical Toxicology Program , Boston Children's Hospital , Boston , MA , USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Toce
authors.affiliation: a Harvard Medical Toxicology Program , Boston Children's Hospital , Boston , MA , USA.|b Division of Emergency Medicine, Department of Medicine , Boston Children's Hospital , Boston , MA , USA.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Burns
authors.affiliation: a Harvard Medical Toxicology Program , Boston Children's Hospital , Boston , MA , USA.|c Division of General Pediatrics, Department of Medicine , Boston Children's Hospital , Boston , MA , USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: O'Donnell
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning*; D000931:Antidotes / Q000008:administration & dosage; D002047:Buprenorphine / Q000506:poisoning*; D000069479:Buprenorphine, Naloxone Drug Combination / Q000506:poisoning*; D002606:Charcoal / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009292:Narcotic Antagonists / Q000506:poisoning*; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000378:metabolism; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000931:Antidotes; D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D002606:Charcoal; D002047:Buprenorphine; D010100:Oxygen
keywords: Poisoning; injury prevention; opioids; overdose