Exploring Acupuncture as a Treatment for Neonatal Abstinence Syndrome: A Systematic Review
Background
Neonatal Abstinence Syndrome (NAS) is a drug-withdrawal condition that primarily occurs in newborns exposed to opioids during pregnancy. Infants with NAS may exhibit withdrawal symptoms such as high-pitched crying, tremors, and sleep-wake cycle disturbances. Diagnosis typically involves standardized withdrawal assessments like the Finnegan score. Standard treatments for NAS include swaddling, rooming-in, breastfeeding, and, when necessary, pharmacological intervention with oral opioids. However, the optimal management strategy for NAS remains a topic of debate. Acupuncture has been suggested as a potential complementary therapy. This technique involves stimulating specific points on the body either invasively (using thin metal needles) or non-invasively (through acupressure or laser).
Objectives
This systematic review aimed to assess whether acupuncture (including acupressure, needle acupuncture, and laser acupuncture) reduces the duration of pharmacological treatment for NAS, decreases adverse events, and shortens hospital stays for newborns with the condition.
Search Methods
A comprehensive literature search was conducted across multiple databases (CENTRAL, PubMed, Embase) and trial registries. Additional sources included reference checking, citation searching, and direct contact with study authors. The most recent search was performed on August 25, 2023.
Selection Criteria
Eligible studies included randomized controlled trials (RCTs), quasi-RCTs, and cluster-randomized trials. Participants were full-term and late preterm infants diagnosed with NAS within 72 hours after birth, as determined by a standardized NAS assessment tool (e.g., Finnegan score >8). Studies comparing acupuncture (invasive or non-invasive) with no intervention, placebo, pharmacological treatment, or alternative acupuncture techniques were included. Acupuncture could be used as a standalone intervention or as an adjunct to conventional NAS treatment.
Data Collection and Analysis
Standard Cochrane methodological procedures were followed, with primary outcomes focusing on the duration of pharmacological treatment for NAS, adverse events, and length of hospital stay. The GRADE approach was used to evaluate the certainty of the evidence.
Main Results
Two single-center RCTs with a total of 104 infants met the inclusion criteria. Both studies assessed non-invasive acupuncture in combination with standard care versus standard care alone. No studies were found comparing acupuncture with placebo, pharmacological treatment, or other acupuncture techniques. Additionally, no ongoing studies were identified.
Study 1 (Austria, 2009–2014, 28 infants): A prospective, blinded RCT investigating laser acupuncture. Treatment involved daily laser acupuncture at ear and body points until morphine was discontinued.
Study 2 (USA, 1992–1996, 76 infants): A randomized, prospective, unblinded study on acupressure. This intervention involved taping a small herbal seed to an ear acupoint and massaging it for 30–60 seconds after each NAS scoring event.
Key Findings:
Duration of Pharmacological Treatment for NAS:
Study 1: Median duration was 28 days (IQR 22–33) in the acupuncture group vs. 39 days (IQR 32–48) in the control group.
Study 2: Mean duration was 22.1 days (SD 16.6) in the acupuncture group vs. 22.7 days (SD 13.8) in the control group (MD -0.60, 95% CI -7.45 to 6.25).
Adverse Events:
No adverse effects were reported in either study (RD 0.00, 95% CI -0.05 to 0.05; 2 studies, 104 infants; I² = 0).
Length of Hospital Stay:
Study 1: Median stay was 35 days (IQR 25–47) in the acupuncture group vs. 50 days (IQR 36–66) in the control group.
Study 2: Mean hospital stay was 25.8 days (SD 16.4) in the acupuncture group vs. 26 days (SD 13.3) in the control group (MD -0.20, 95% CI -6.90 to 6.50).
Highest NAS Score:
Study 1: Median score was 15 (IQR 13–18) in the acupuncture group vs. 16 (IQR 14–19) in the control group.
Study 2: Average NAS score per scoring event was slightly higher in the acupuncture group (mean 5.27, SD 1.04) compared to the control group (mean 4.95, SD 1.00).
The certainty of evidence was deemed very low for all outcomes. No studies provided data on all-cause mortality, pain levels, or long-term follow-up.
Authors' Conclusions
The limited available evidence does not provide sufficient support for acupuncture as a routine treatment for NAS in newborns. Although both included studies examined non-invasive acupuncture and reported no adverse effects, the findings are based on a small sample size. Given these limitations, clinicians should exercise caution when considering acupuncture for NAS management. Further well-conducted, large-scale RCTs are necessary to assess the benefits and risks of acupuncture for NAS. Future studies should also compare different acupuncture techniques and treatment sites to evaluate their effectiveness and feasibility.
Final Thoughts
While acupuncture remains a promising complementary therapy, the current evidence does not justify its widespread use for NAS. Additional research is essential to clarify its role in neonatal care and determine whether it can effectively reduce NAS symptoms and improve clinical outcomes.
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