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 Post subject: Methadone for NAS?
PostPosted: Thu Sep 05, 2013 4:18 pm 
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Are there any other mothers here with a baby that was treated for NAS with methadone? How long did it take for the baby to be weaned off of it? I searched on Google but all I could find was information that had to do with morphine. The nurses told me it can take up to three months :(


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 Post subject: Re: Methadone for NAS?
PostPosted: Thu Sep 05, 2013 4:46 pm 
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I do not have direct experience but a very dear friend of mine adopted a baby a couple years ago and when the baby was born, it was clear he was in withdrawal. They put the baby boy on methadone and it took approximately one month to properly ween him down. He was positive for opiates but I don't know what kind.. probably not bupe.

(My friends, who adopted the baby boy, lived 3 hours away by plane and had to continuously fly back and forth to take turns caring for their older Son, and being by the baby's side.)


Last edited by tinydancer on Thu Sep 05, 2013 5:19 pm, edited 1 time in total.

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 Post subject: Re: Methadone for NAS?
PostPosted: Thu Sep 05, 2013 5:04 pm 
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Oh yeah, baby boy is now fine and healthy! He's 2 now. My friends chose adoption because they couldn't get pregnant and make it stick. She had 6+ miscarriages. During the first weekend of being in Florida to stay near the hospital after delivery, they were intimate once, by the time they were able to bring the baby home, my friend found out she was pregnant. This time it stuck. So now they have 2 healthy boys exactly 9 months apart.

Here's an article I found on a quick search:

It looks like Morphine is the standard in NAS treatment, especially for community hospitals, but some hospitals do use methadone.

http://www.pqcnc.org/documents/nas/nasr ... ELINES.pdf

Treatment Choice: Short-acting Opioid or Methadone?
• community hospitals should treat infants with shortacting agents such as morphine sulfate or dilute tincture
of opium and wean the infant completely off medication
prior to discharge
• most hospitals treat Nas with short acting morphine
sulfate (sarkar & donn, 2006

Methadone Treatment at Fletcher Allen Health Care
• starting dose: 0.3 mg po q12 hours (range of 0.3–0.6 mg
po q12 hours depending upon severity of signs)
• if scores are ≥9 after first dose, consider giving an
extra dose of 0.3 mg of methadone (independent of the
regular doses which should continue)
• if scores are ≥9 after 4 scheduled doses, consider
increasing dose by 0.05–0.2 mg
• most infants will not need more than 0.5 mg po q12
hours
• when scores are < 9 for 24–48 hours on a stable
methadone dose, may discharge home
• if infant is somnolent, does not rouse spontaneously
for feeds, or has abnormal eye movements, discontinue
methadone immediately and continue scoring. if or
when scores approach 7 or greater, restart methadone
at lower dose using following guide:
• No methadone dose for 24 hours: decrease
by 0.05 mg
• No methadone dose for 36 hours: decrease dose
by 0.1 mg
• No methadone dose for 48 hours: decrease dose
by 0.15 mg
• No methadone dose for 72 hours: decrease dose
by 0.2–0.25 mg
• if methadone is not needed by 96 hours and
there are no significant signs of withdrawal,
discharge infant
• infant should remain on cardiorespiratory
monitoring and/or pulse oximetry until stable
dose is achieved and somnolence has resolved


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 Post subject: Re: Methadone for NAS?
PostPosted: Mon Oct 07, 2013 5:42 pm 
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My last born was treated with methadone for Suboxone NAS. We were sent from our original hospital to a Childrens Hospital the day we were suppose to discharge. When I heard the use of methadone my heart dropped. I was on subutex with 3 pregnancies. My first had some NAS and was treated with morphine. The second and third I tappered down and stopped about a week before the second and two weeks before the third. We were sent home right away with the second and later at home I noticed some sneezing. We were told Childrens Hospital had the newest standard of care for "Methadone" babies. If we would have lived closer or even in the same state our son would have started the methadone weaning and sent home in three to 5 days and do the weaning at home. The baby would have been brought back to the doctors there for check ups. Our family doctor was on vacation so we had to stay one week because we had no one take care of him once we got home. When they did get a hold of him, he felt uncomfortable taking our baby on, there was the issue of getting the methadone and home health nurse. The doctor at Childrens didn't think our child had withdrawal and stopped the treatment right then to see if we could get him home in 4 days. They kept taking away the methadone and his score kept going down. Our son was originally sent to Childrens for observation. The doctor wanted him watched for a few hours before anything was desided. He had to ride in an incubator in an ambulance with out me for 2 hours. His NAS score was very high upon arriving. The doctor wanted to watch some more, but the nurse got the nurse practitioner to start therapy. I arrived 5 mins before the first dose was given. He just snuggled unto me and relaxed when I arrived. I few mins later it was out of our hands. It was an issue that the nurses, nurse-practitioners, doctors, and pain specialists kept debating on was he ever in withdrawal, did he have it, ect. After 5 or 6 days the doctor discontinued the methadone. We had to stay for 96 hours to watch for withdrawal because of the long 1/2 life. We were going to be going home that Sunday if everything was all well. Our son didn't sleep well that Saturday night and was fussy SUNDAY morning. Sunday morning a new doctor on rounds started the methadone back up on the same dose he had been at 3 days ago. Nurse-practitioners begged during rounds to give a small prn dosage and wait and see what happens or if medication was to be started to drop his dose by 1/2 to 3/4's. We were there all week trying to get things in order to go home and finish the treatment at home. We got to go home when our son was 18 days old. We had in home nursing staff check him out 2 times a week and a doctor appointment once a week. The nursing staff for the most part was mainly concerned with medication counts. The first 5 or 6 days at home were as easy as the hospital. Then our son was very difficult to comfort. I walked him around the clock. Only time he slept was for a few hours after his methadone dosage. We were sent back to Childrens for a few days because of lack of weight gain. The slowed the weaning down. Didn't help much. He was on methadone for 10 weeks. The last week was HELL. He had been taking the dosages 2xs Per day. It was dropped to once per day for three days, then nothing. He was misserable the entire week. The way our son acted on day three in the hospital with no meds was a picnic to that last week at home. After 2 days of no medication it started the other way. The sound of his cry was different, he was easier to comfort, better sleeping. If he wasn't addicted at birth he was after 10 weeks of methadone.
The hospitals like it because they can discharge these babies instead of keeping them for a few weeks. Nursing staff like the once a day or twice a day administration vs every 4 to 6 hours with morphine. Maybe methadone works great for wemon that were taking methadone while pregnant. I don't think it is the best treatment for Subutex babies. While I was there 2 other NAS babies came through. Sent home in less than a week on methadone. Those babies screamed there heads off the first 2 to 3 days. I was able to comfort my son through constant movement, tight wrapping and snuggling, and breast feeding.


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 Post subject: Re: Methadone for NAS?
PostPosted: Mon Oct 07, 2013 8:38 pm 
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Sorry to hear about all that, secondchance.

Seems like a common story around here. It's great that you were so on top of things and by your baby's side the whole time. It's unfortunate that it's still quite a guessing game as far as NAS is concerned and it's even more unfortunate when an infant is placed on methadone treatment when there is no need. I guess a lot of doctors prefer to "play it safe".. It still seems just as complicated because, eventually, the baby will just withdrawal from the medicine s/he was given anyway. Sigh.. So sad.

Thank you for sharing your story.


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