UMEM Educational Pearls

Title: Buprenorphine/naloxone (Suboxone) exposure in pediatric population

Keywords: buprenorphine exposure, pediatrics, retrospective study (PubMed Search)

Posted: 10/26/2016 by Hong Kim, MD
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Recently, a retrospective study of unintentional buprenorphine/naloxone exposure among pediatric population was published. All patients were evaluated by toxicologists at the time of initial hospital presentation (or transfer) at the study center.

Bottom line

83% and 80% of the patients experienced respiratory and CNS depression, respectively.

Majority of the patients became symptomatic within 8 hours of exposure (range not available).

Naloxone reversed respiratory depression. Median dose for single naloxone dose: 0.09 mg/kg; median dose for multiple naloxone doses: 0.19 mg/kg.

The reported “ceiling effect” on respiratory depression in adult does not exist in pediatric population.

The optimal time of observation is unclear but it is prudent to observe pediatric buprenorphine exposure for up to 24 hours.

Additional Information

A retrospective study of single center/referral center’s toxicology consultation service.

88 patients were included. (median age: 24 months [range: 10 to 77 months]). Majority were transferred from other hospitals.

Sources of the medication were

Primary caregiver (65%)
Other relatives (17%)
Parent’s friends (14%)

Clinical effects

Respiratory depression: 83%
SpO2 < 93%: 28%
CNS depression: 80%
Miosis: 77%
Emesis: 45%
Agitation: 5%

Naloxone

55% of the patients received naloxone
Two patients received naloxone 8 – 12 hours and >12 hours after exposure due to respiratory depression.

The median hospital stay was 22 hours (7 - 248 hours).

41% (n = 36) were admitted to ICU.
The reported exposure dose was the only factor that was significantly associated with length of stay in a multivariate analysis (other variables: sex, age and time to presentation)

References

2016 Oct 19:1-6. [Epub ahead of print]

_{Clinical effects of unintentional pediatric buprenorphine exposures: experience at a single tertiary care center.}

Toce MS1, Burns MM1,2, O'Donnell KA1,3.