Methadone Demonstration Project With Neonatal Intensive Care Unit Infants Diagnosed With Neonatal Abstinence Syndrome

Phase 2

Terminated

Conditions: Neonatal Abstinence Syndrome

Interventions: Drug: Methadone
Drug: Morphine

Registration Number: NCT03134703

Lead Sponsor: Johns Hopkins All Children's Hospital

Brief Summary: This is a non-randomized, un-blinded feasibility study project comparing the Length of Stay (LOS) of Neonatal Intensive Care Unit (NICU) infants diagnosed with Neonatal Abstinence Syndrome (NAS) treated with methadone with historical data and a comparison group of NICU NAS infants treated with a different narcotic agent.

Detailed Description: For the time frame July 1, 2013 through September 30, 2014, 300 infants with NAS have been cared for in the JHACH NICU with an average length of stay of 30 days. Such a prolonged length of stay has a negative impact on maternal/infant bonding. In addition, infants suffering from NAS have poor regulatory mechanisms and are invariably hard to care for and difficult to console, and they provide an emotional challenge to their caretakers. This challenge becomes even more significant when the caretaker is the mother who is suffering from addiction and is already emotionally compromised by feelings of depression, anxiety, guilt or insecurity. Attachment is an ongoing process and the quality of the relationship between mother and her infant directly influences the structure of the child's affective ties and overall organization of responses to environment. This mother-infant bond sets the stage for understanding and identifying the infant's needs and reciprocal parental response to those needs. Maternal emotional unavailability has potentially serious effects on the long term mother-child relationship, and on the child's development.

This project provides a novel approach and an alternative care plan for infants with NAS. It is funded by the State of Florida and allows to: 1) educate and empower a specified population of mothers who are undergoing institutionalized rehabilitation and whose infant needs treatment for NAS; 2) safely transition the infants home for final wean of their pharmacologic treatment; 3) provide regular developmental follow up for these infants through our NICU follow up clinic, hence identifying and quickly responding to neuro-developmental delays.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 11

Inclusion Criteria

Baby is diagnosed with neonatal abstinence syndrome;
Newborns ≥ 37 0/7 weeks gestation;
Newborns transferred to JHACH within 72 hours from birth;
Newborns ≥ 2.5 kg weight at birth;
Informed parental consent.

Exclusion Criteria

Infant not requiring pharmacologic treatment for NAS;
Major congenital anomalies;
Major concomitant medical illness including planned antibiotic treatment for greater than 3 days or NPO status;
Infants who are being placed for adoption;
Infants in significant pain requiring narcotic medication for comfort (for example those with a fracture);
Mother with hearing or language impairment;
Infants known upon admission who will be placed into state custody or sheltered.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Methadone Treatment Group	Methadone	NAS infants treated for withdrawal symptoms with methadone
Comparison Group	Morphine	NAS infants treated for withdrawal symptoms with morphine (standard of care at Johns Hopkins All Children's Hospital)

Primary Outcome Measures

Name	Time	Method
Length of Stay (LOS)	25 days	Compare the LOS of Neonatal Intensive Care Unit (NICU) infants with Neonatal Abstinence Syndrome (NAS) treated with methadone with historical data and a comparison group of NICU NAS infants treated with a different narcotic agent.

Secondary Outcome Measures

Name	Time	Method
Readmission to Hospital	Within 30 days of discharge	Number of hospital readmissions
Maternal Bonding Measured With The Postpartum Bonding Questionnaire (PBQ)	inpatient and at 6-8 weeks of age	The Postpartum Bonding Questionnaire (PBQ) is a self-rating questionnaire designed to detect disorders of the mother-infant relationship. The questionnaire has 25 statements, each with six alternative responses ranging from 0 (always) to 5 (never). For the PBQ, scores are summated for each factor, with a high score indicating concern for bonding. The PBQ yields a total score between 0 to 125. Positive responses are scored from 0 ('always') to 5 ('never'). Negative responses, are scored from 5 ('always') to 0 ('never'). Factor 1 (impaired bonding) is based on 12 questions, with a score range 0-60 (0-11=normal; 12 \& above=high). Factor 2 (rejection \& anger) is based on 7 questions with a score range 0-35 (0-16=normal; 17 \& above=high). Factor 3 (anxiety about care) is based on 4 questions with a score range 0-20 (0-9=normal; 10 \& above =high). Factor 4 (risk of abuse) is based on 2 questions, with a score range 0-10 (0-2=normal; 3 \& above =high).
Maternal Depression Measured With The Edinburgh Postnatal Depression Scale (EPDS)	While inpatient and at 6-8 weeks of age	The Edinburgh Postnatal Depression Scale (EPDS) was developed for screening postpartum women in outpatient, home visiting settings, or at the 6-8 week postpartum examination. The EPDS is a 10-item questionnaire with responses scored 0, 1, 2, or 3 according to increased severity of the symptom. The maximum total score is 30 while the minimum score is 0. A score of 10 or greater, as well as any answer choice other than "never" on question #10 (suicidal thoughts) of the EPDS are indicative of depressive symptomatology.
Breast Milk	30 days of age	Compare the incidence of providing breast milk (\> 50% of nutritional needs) at 30 days of age between methadone treated and non-treated infants
Infant Development	4, 8 and 12 months of age	Assess the age appropriate infant development at 4, 8 and 12 months of age among the methadone treatment group using the Ages and Stages-based questionnaires (ASQ). The questionnaires are screening tools designed to identify infants at risk for developmental delays through caregivers' provision of quantitative information regarding their infant's development. In the ASQ, higher scores indicate more positive outcomes. The ASQ covers 5 areas of development: communication, gross motor, fine motor, problem solving, and personal-social. Scores for each area should fall between 0-60. Scoring: 0-30 = further assessment with a professional may be needed 30-40 = learning activities \& monitoring are indicated 45-60 = child development appears to be on schedule
Screened vs. Eligible	After accrual of the first 50% of participants & after accrual of the second 50% of participants, and at completion of the trial.	Determine the response percentage of mothers who are screened as eligible by PAR officials and who agree to participate in the demonstration project
Attrition Rate	After accrual of the first 50% of participants, after accrual of the second 50% of participants, and at completion of the trial.	Assess the drop out percentage of mothers who agree to participate but do not follow through with home discharge for continued care
Home Care	After accrual of the first 50% of participants, after accrual of the second 50% of participants, and at completion of the trial	Quantitate the proportion of mothers who feel comfortable with home care of their infant at discharge
Readiness of Mothers to Assess Infant	After accrual of the first 50% of participants, after accrual of the second 50% of participants, and at completion of the trial.	Monitor the readiness of mothers to assess infant on 3 to 4 hours intervals while at home
Compliance With Pediatrician Visits	After accrual of the first 50% of participants, after accrual of the second 50% of participants, and at completion of the trial.	Determine the compliance rate with the Johns Hopkins All Children's Hospital (JHACH) pediatrician visits.