Naloxone for opioid-exposed newborns: 5 years, 1 opioid epidemic, nothing has changed

  • Moe-Byrne T & al.
  • Cochrane Database Syst Rev
  • 12 Oct 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For newborns exposed to opioids in utero, evidence remains insufficient to support naloxone (e.g., Narcan) use with cardiorespiratory or neurological depression.
  • Naloxone for infants chronically exposed in utero has not been assessed; trial results for acute exposure during birth show no compelling effects on outcomes.  
  • All included trials are >30 years old.

Why this matters

  • The opioid antagonist naloxone can be used for newborns suffering adverse effects of in utero opioid exposure, but benefits vs harms are unclear.
  • Review updates a 2013 Cochrane report by the same group, with no new trials added or new conclusions, despite ongoing threats of the opioid epidemic. 

Key results

  • None of the trials specifically included infants with respiratory or neurological depression.
  • None examined infants whose mothers had used opioids while pregnant.
  • The authors cite “some evidence” of benefit of naloxone for alveolar ventilation in trials measuring respiratory function within 6 hours of birth. 
  • No trial evaluated child development over the long term.

Study design

  • Cochrane review, 9 trials included, all of them more than 30 years old, and quite small, with only 316 infants total. 
  • Funding: University of York; UK National Institute for Health Research; Vermont Oxford Network, USA.

Limitations

  • Very old, small trials.

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