Auricular Acupressure Augmentation of Standard Medical Management of the Neonatal Narcotic Abstinence Syndrome

Background: Several small studies suggest that auricular acupuncture facilitates narcotic withdrawal in opiate-dependent adults. Effects in neonates with narcotic abstinence syndrome (NAS) are unknown. Objective: The objective of this study was to determine if auricular acupressure augmentation of standard medical management decreased length of hospital stay for NAS care or improved infant comfort. Design: This > 4-year randomized, prospective, but unblinded study started in March 1992 and ended in August 1996. Setting: The trial was conducted at an inpatient pediatric service of the Boston City Hospital (now Boston Medical Center), in Boston, MA. Participants: The study subjects were 76 neonates with NAS after in utero exposure to maternally ingested opiates (heroin, methadone). Intervention: Auricular acupressure augmentation of standard NAS medical management was the intervention for this trial. Study Design: Demographic characteristics distributed similarly for mothers of control and acupressure treatment subjects, as was true for baby gender, gestational age, birth weight, Apgar scores, and urine toxicology for opiates. The subjects were divided into two groups (control and acupuncture). Main Outcome Measures: The primary outcome measure was length of hospital stay for NAS care. The secondary outcome measures were average NAS score/scoring event and total amount (mg/kg/inpatient day of NAS care) of pharmacologic support. Results: There were no significant (P-value ≤ 0.05) differences between control (n = 37) and acupressure treatment groups (n = 39), respectively, in: NAS length of stay (median: 22.4 days; [interquartile range (IQR): 17.6-32.3] versus 22.6 days [IQR: 16.5-28.4]); average NAS score per scoring event (median: 4.98 [IQR: 4.37-5.69] versus 5.42 [IQR: 4.33-6.16]); or mg/kg/NAS inpatient days of care of pharmacologic support. Conclusions: Although the duration and course of inpatient NAS care did not differ between control and treatment subjects, this study demonstrates the feasibility of clinical research in this cohort and provides a framework for future prospective studies seeking to determine the potential efficacy of conventional allopathic, acupuncture-based, or other complementary interventions in the treatment of NAS. Key Words: Neonatal Abstinence Syndrome (NAS), Acupressure, Neonate