Morphine and Methadone for Neonatal Abstinence Syndrome: A Systematic Review

Neonatal Netw. 2018 Nov;37(6):365-371. doi: 10.1891/0730-0832.37.6.365.


Purpose: To compare the effects of morphine and methadone on length of hospital stay (LOS) or treatment (LOT) and adverse effects in infants with neonatal abstinence syndrome (NAS).

Design: Systematic review.

Sample: PubMed, Google Scholar, Cochrane library, CINAHL, IPA, American Academy of Pediatrics, and were systematically searched to identify randomized controlled trials (RCTs) and observational studies. comparing morphine and methadone for NAS.

Outcomes: LOS, LOT, adverse effects.

Results: One RCT, two cohort studies, and two chart reviews met inclusion criteria. Each had a low risk of bias. LOS ranged from 12.08 to 36 days with morphine and 21 to 44.23 days with methadone. LOT ranged from 7.46 to 22.9 days (morphine) and 13.9 to 38.08 days (methadone). Adverse effects were not reported. Clinical evidence comparing morphine to methadone for NAS treatment is limited and conflicting. A recommendation for one over the other cannot be made based on these outcomes.

Keywords: neonatal abstinence syndrome (NAS); neonatal withdrawal; pharmacology.

Publication types

  • Comparative Study
  • Systematic Review

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay / statistics & numerical data*
  • Male
  • Methadone / therapeutic use*
  • Morphine / therapeutic use*
  • Narcotics / adverse effects*
  • Neonatal Abstinence Syndrome / drug therapy*
  • Opioid-Related Disorders / drug therapy*
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Pregnancy Complications / etiology
  • United States


  • Analgesics, Opioid
  • Narcotics
  • Morphine
  • Methadone