Background: Buprenorphine is a semi-synthetic opioid used for the treatment of opioid dependence. Opioid use,\nincluding buprenorphine, has been increasing in recent years, in the general population and in pregnant women.\nConsequently, there has been a rise in frequency of neonatal abstinence syndrome (NAS), associated with buprenorphine\nuse during pregnancy. The purpose of this study was to investigate correlations between buprenorphine and\nbuprenorphine-metabolite concentrations in cord blood and onset of NAS in buprenorphine exposed newborns.\nMethods: Nineteen (19) newborns who met inclusion criteria were followed after birth until discharge in a doubleblind\nnon-intervention study, after maternal consent. Cord blood and tissue samples were collected and analyzed by\nliquid chromatographyââ?¬â??mass spectrometry (LCââ?¬â??MS) for buprenorphine and metabolites. Simple and multiple logistic\nregressions were used to examine relationships between buprenorphine and buprenorphine metabolite concentrations\nin cord blood and onset of NAS, need for morphine therapy, and length of stay.\nResults: Each increase in 5 ng/ml level of norbuprenorphine in cord blood increases odds of requiring treatment by\nmorphine 2.5 times. Each increase in 5 ng/ml of buprenorphine-glucuronide decreases odds of receiving morphine\nby 57.7 %. Along with concentration of buprenorphine metabolites, birth weight and gestational age also play important\nroles, but not maternal buprenorphine dose.\nConclusions: LCââ?¬â??MS analysis of cord blood concentrations of buprenorphine and metabolites is an effective way to\nexamine drug and metabolite levels in the infant at birth. Cord blood concentrations of the active norbuprenorphine\nmetabolite and the inactive buprenorphine-glucuronide metabolite show promise in predicting necessity of treatment\nof NAS. These finding have implications in improving patient care and reducing healthcare costs if confirmed in\na larger sample.
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