Complementary Therapies For Mild to Moderate Neonatal Opioid Withdrawal Syndrome: A Mini-review
Authors:   University of Belgrade, School of Dental Medicine, Belgrade, Serbia, Kovačević Aleksandar Mihailo , Abiola Adefidipe Adeyemi ,   Obafemi Awalowo University Teaching Hospitals Complex, Ile IFe, Nigeria, Almarie Ahmad ,   Principles and Practice in Clinical Research, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States,   Toothpick Portal LLC, Dubai, UAE, Sayed Amina ,   Obstetric and Gynaecology Department, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK, Ruiz de Castilla Andre Sorolla ,   Esperantra, Cancer and Rare Diseases Patient Association, Lima, Peru, Goenawan Angel ,   Bayhealth Medical Center, Department of Internal Medicine, Sussex Campus, Milford, Delaware, USA, Cesar Bruno Nogueira ,   DF STAR Hospital, Brasilia, Brazil, Parikh Charmy ,   Carle BroMenn Medical Center, Illinois, USA, Olaya Daniela Ayala ,   Hospital Universitario Mayor Mederi, Hepatobiliary and Pancreatic Surgery Group, Bogota, Colombia, Vial Felipe ,   Clínica Alemana, Santiago, Chile, Standen Francisco ,   Clínica Davila Vespucio, Santiago, Chile, Rocco Franco Daniel ,   Charles Centro Oftalmológico, Buenos Aires, Argentina, Chinelato Juliana Rosa ,   Hospital Sírio Libanês, Department of Clinical Oncology, São Paulo, Brazil, de Freitas Marcelo Carlos ,   Clínica MCF, São Paulo, Brazil, Petri Dias Natalia ,   Hospital Infantil Sabará, São Paulo, Brazil, Betiku Omolade ,   Department of Morbid Anatomy & Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, de Oliveira Junior Silvio Porto ,   Bahiana School of Public Health and Medicine, Bahia, Brazil, Kozak Sylwia ,   University Hospital of Basel, Switzerland, Mendez Castellanos Sonya Grisel ,   Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic, Almarie Bassel ,   Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, Soto Enrique E ,   Principles and Practice in Clinical Research, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
Published: April 2024

Introduction: Neonatal Opioid Withdrawal Syndrome, resulting from prenatal opioid exposure, is rising in prevalence and presents substantial health and developmental challenges for neonates. While standard treatments of opioids such as morphine have been traditionally employed for treatment, concerns about their long-term effects on neonatal development have spurred interest in alternative therapeutic strategies. This review seeks to highlight emerging non-opioid interventions for Neonatal Opioid Withdrawal Syndrome and their potential benefits. Methods: Utilizing the PRISMA framework, the database PubMed was systematically searched for complementary therapies for neonatal opioid withdrawal syndrome. The search was conducted on September 27th, 2023, and employed a combination of keywords targeting the condition and the treatment modalities. Cochrane risk of bias tool was utilized to evaluate study quality and classify studies based on their risk of bias. Data captured from these studies encompassed parameters such as study design, intervention, and outcomes, including length of stay and length of pharmacotherapy. Results: Among 71 identified articles, only five met the inclusion criteria. Three were randomized controlled trials, and two were quasi-experimental studies. Among the 5 included trials, 3 demonstrated potential benefits, while two revealed no differences in treatment duration or reliance on pharmacological support. The "Eat-Sleep-Console" method, acupuncture, and vibrating mattresses were associated with reduced morphine dosages and shorter hospital stays. Most trials showed moderate to high risk using the Cochrane RoB-2 tool. Discussion: This review underlines the growing concern of Neonatal Opioid Withdrawal Syndrome stemming from increased opioid use during pregnancy. While severe cases necessitate pharmaceutical treatments, there’s a pressing need for safer alternatives. "Eat-Sleep-Console" method and transcutaneous auricular neuromodulation might offer mild relief. Future efforts should adopt a multifaceted strategy, emphasizing further research to optimize treatments and outcomes. Conclusion: Although complementary therapies show promise, with limited evidence from three RCTs, their efficacy remains uncertain. Additional studies might clarify the role while combining it with pharmacological methods could enhance outcomes. Comprehensive research is essential to optimize treatments for NOWS-affected infants. Complementary therapies in mild to moderate cases of Neonatal Opioid Withdrawal Syndrome show promising results. So far, not enough data has been obtained to support the efficacy of observed therapies.