Opioids, Methadone and Babies

LOS ANGELES (August 8, 2023) - Whatever the opioid crisis calls to mind, it likely isn’t pacifiers and diapers. But when 1 out of every 5 hospitalized infants receives opioids, and when some infants require methadone treatment, it’s time to widen the scope. A new study led by pediatric surgeons at Children’s Hospital Los Angeles shows that methadone use after surgery can prolong a baby’s recovery and increase an infant’s dependence on ventilators and intravenous (IV) nutrition.

To call the opioid problem in the United States a crisis is not hyperbole. The rate of death due to opioid overdose has risen exponentially in the last 10 years, reaching 80,000 in 2021 alone. But the dangers of opioids are not limited to overdose.

Opioids are highly addictive—and withdrawal can be severe. “It seems unbelievable, but the same thing happens to babies,” says Lorraine Kelley-Quon, MD, MSHS, a pediatric surgeon at CHLA. “If you abruptly stop opioids in babies, they can show signs of withdrawal—irritability, intestinal problems or even seizures.” For this reason, babies receiving a prolonged course of opioids may need to be weaned off of them with methadone, a longer-acting, weaker opioid.

In her latest study, published in JAMA Network Open, Dr. Kelley-Quon examined how methadone use impacted recovery in infants. The study included over 2,000 babies from 48 children’s hospitals who were surgically treated for necrotizing enterocolitis (NEC), a life-threatening inflammatory condition that can develop in premature newborns. While rare, NEC is the most common reason for emergency surgery in newborn babies.

The findings: Babies who required methadone needed to stay in the hospital an average of 21 days longer after surgery. They also required more days on the ventilator and longer reliance on IV nutrition.

“It ends up being a snowball effect,” she says. “The longer a baby is on opioids, the more likely the need for methadone, which is still an opioid.” Side effects of opioids are respiratory depression and decreased intestinal motility.

So why are opioids given to babies in the first place? The answer is simple: babies in the hospital may need surgery or painful interventions, and opioids are effective at treating their pain. However, babies can’t take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain, like older children can. “Nobody wants a baby to be in pain,” says Dr. Kelley-Quon. “We don’t want to stop using opioids, especially when a baby is undergoing an operation. What we do want is to understand the impact of opioids and use them more judiciously.”

More judicious use of opioids doesn’t just mean limiting prescriptions. It also means standardizing opioid use. "We found such a wide range in what hospitals were doing,” she says. “In some hospitals, over 40% of infants received methadone. In other hospitals, methadone isn’t used at all.” This wide variability points to the need to standardize opioid and methadone use among hospitals.

Dr. Kelley-Quon has spent the last several years uncovering how widespread the impact of the opioid epidemic fallout has become for children. A few years ago, she established the first evidence-based guidelines for safer pain management in children and adolescents. Her work continues to uncover the need for what she calls “opioid stewardship.”

Other authors on the study include first author Olivia A. Keane, MD; Abigail K. Zamora, MD; Shadassa Ourshalimian, MPH; Elaa M. Mahdi, MD, MPH; Ashley Y. Song, MPH, PhD; Eugene Kim, MD and Ashwini Lakshmanan, MD, MPH.

The study was supported by grant KL2TR001854 from the National Center for Advancing Translational Science (NCATS) and grant R01HD105656 from the National Institute of Child Health and Human Development of the National Institutes of Health (NIH).

About Children’s Hospital Los Angeles

Children’s Hospital Los Angeles is at the forefront of pediatric medicine, offering acclaimed care to children from across the world, the country and the greater Southern California region. Founded in 1901, Children’s Hospital Los Angeles is the largest provider of care for children in Los Angeles County and the No. 1 pediatric hospital in California and the Pacific region, and is consistently ranked in the top 10 in the nation on U.S. News & World Report’s Honor Roll of Best Children’s Hospitals. Clinical expertise spans the pediatric care continuum from newborns to young adults, from everyday preventive medicine to the most medically complex cases. Inclusive, compassionate, child- and family-friendly clinical care is led by physicians who are faculty members of the Keck School of Medicine of USC. Physicians translate the new discoveries, treatments and cures proven through the work of scientists in The Saban Research Institute of Children’s Hospital Los Angeles—among the top 10 children’s hospitals for National Institutes of Health funding—to bring answers to families faster. The hospital also is home to one of the largest training programs for pediatricians in the United States. To learn more, follow us on Facebook, Instagram, LinkedIn, YouTube and Twitter, and visit our blog at CHLA.org/blog.