• Posted August 9, 2023

Some Newborns Need Methadone Post-Surgery, But Use Brings Problems

About 1 in 5 newborns hospitalized for surgery to treat a life-threatening bowel infection are given opioids for pain relief and some then need methadone to wean off the addictive drugs.

But there is wide variability in use of opioids after surgery in infants, and babies who need methadone tend to remain in the hospital a lot longer, a new study shows.

“Nobody wants a baby to be in pain," explained co-author Dr. Lorraine Kelley-Quon, a pediatric surgeon at Children's Hospital Los Angeles. “We don't want to stop using opioids, especially when a baby is undergoing an operation. What we do want is to understand the impact of opioids and use them more judiciously."

She noted that babies can't take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain, like older children can.

Of infants who receive a prolonged course of opioids, some require methadone to relieve withdrawal symptoms, which can be severe.

“It seems unbelievable, but the same thing happens to babies,” Kelley-Quon said in a hospital news release. “If you abruptly stop opioids in babies, they can show signs of withdrawal -- irritability, intestinal problems or even seizures."

Methadone is a longer-acting, weaker opioid.

For this study, published recently in JAMA Network Open, the researchers examined how methadone use affected recovery in infants.

The study included more than 2,000 babies from 48 U.S. children's hospitals who were surgically treated for a life-threatening inflammatory condition that can develop in premature infants, called necrotizing enterocolitis (NEC). It is rare, but the most common reason for emergency surgery in newborns.

On average, babies who required methadone needed to stay in the hospital an average of 21 days longer after surgery, researchers found. They also required more days on the ventilator and longer reliance on intravenous nutrition.

"It ends up being a snowball effect," Kelley-Quon said. "The longer a baby is on opioids, the more likely the need for methadone, which is still an opioid."

Standardizing opioid use may help, she suggested.

"We found such a wide range in what hospitals were doing," Kelley-Quon said. "In some hospitals, over 40% of infants received methadone. In other hospitals, methadone isn't used at all."

More information

The U.S. National Library of Medicine has more on necrotizing enterocolitis.

SOURCE: Children's Hospital Los Angeles, news release, Aug. 8, 2023