Vibrating crib reduces dependence on medications in babies with prenatal opioid exposure

A crib mattress that periodically vibrates may reduce the severity of withdrawal symptoms in newborns with prenatal opioid exposure and, in turn, lower the need for drug treatment, a study has shown.

The use of the vibrating mattress device in the newborn unit reduced the likelihood that an infant would be treated with morphine (adjusted odds ratio [OR], 0.88 hours per day, 95 percent confidence interval [CI], 0.81–0.93 hours per day). [JAMA Pediatr  2023;177:665-674]

Indeed, exposure to the device of 6 hours daily on average translated to a 50-percent relative reduction in morphine treatment, reported a team of US-based investigators from the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and the University of Massachusetts Chan School of Medicine, Worcester, Massachusetts.

In the subgroup of 32 infants transferred to the neonatal intensive care unit (NICU) for morphine treatment and who completed treatment within 3 weeks, those who were vs were not exposed to the vibrating mattress device were discharged from the NICU almost twice as fast (hazard ratio, 1.96, 95 percent CI, 1.01–3.81). This resulted in 3.18 fewer treatment days (95 percent CI, −0.47 to −0.04) and 1.76 mg/kg less morphine administered (95 percent CI, −3.02 to −0.50).

Meanwhile, the vibrating mattress did not confer the same benefits to infants treated with morphine for more than 3 weeks (n=28).

“Reports indicate that, on average, 70 percent of newborns with prenatal opioid exposure receive pharmacotherapy, despite evidence that common-use treatment opioids and other pharmacotherapies impact infant behaviour and development,” the investigators said. [Hosp Pediatr 2018;8:15-20; Brain Sci 2014;4:321-334; Pain 2011;152:1391-1397; J Pediatr 2016;172:81-87.e2]

“Together, these findings support the efficacy of [the vibrating mattress device] for reducing medication treatment in newborns with prenatal opioid exposure, which has implications for improved neurodevelopmental outcomes, as well as associated hospitalization stays, subsequent cares, and care costs,” they added. [Hosp Pediatr 2018;8:15-20; Front Pediatr 2017;5:216]

The sense of touch

The crib mattress is uniquely constructed and delivers a low-level stochastic vibrotactile stimulation (SVS), with a 3-hour on-off cycle, according to the investigators.

Tactile sensory stimulation has been shown to promote physiologic maturation and brain development, as well as improve behaviours linked to intrauterine drug exposure. Furthermore, stochastic (ie, random, noisy) mechanostimulation has shown promise in restoring destabilized biological systems. [Front Pediatr 2018;6:45; Physiol Behav 2019;207:55-63; J Neonatal Perinatal Med 2022;15:559-565; Pediatrics 2015;136:e1561-e1568; Biomed Eng Lett 2021;11:383-392]

Given that infants with prenatal opioid exposure present with characteristic withdrawal symptoms and dysregulated behaviours of the central and autonomic nervous systems commonly attributed to neonatal abstinence syndrome/neonatal opioid withdrawal syndrome, the investigators believe that daily administration of SVS complementary to standard care would reduce the severity of withdrawal symptoms and dysregulated behaviours in this population.

“Caregiver holding time also reduced the likelihood of morphine treatment (OR, 0.90 hours per day, 95 percent CI, 0.86–0.94), and [the effect] was equivalent to that observed with SVS. In contrast, duration in standard of care hospital-issued motorized seats had no effect. The more tactile stimulation, either by gentle SVS vibration or caregiver hold, the lower the likelihood of pharmacologic treatment,” the investigators noted.

“These findings support the importance of mechanosensory stimulation for reducing withdrawal symptoms and promoting regulated systems. While there is no replacement for natural touch by a caregiver to an infant, given that caregivers are not always available to hold infants in the hospital setting, SVS may provide a beneficial intervention to promote health equity and improve clinical outcomes among vulnerable newborns with prenatal opioid exposure,” they added. [Paediatr Child Health 2010;15:153-156; Physiol Behav 2019;207:55-63; Neurotoxicol Teratol 2022;92:107105]

Study details

The study included 181 newborns with prenatal opioid exposure who completed hospitalization at the study sites (mean gestational age 39.0 weeks, mean birth weight 3,076 g, 55.2 percent girls). Half of them received treatment as usual (TAU), and the other half received standard care plus low-level SVS through the vibrating crib mattress within 48 hours of birth. All infants whose symptoms met clinical criteria for pharmacologic treatment received morphine in the NICU per standard care.

A total of 121 infants (66.9 percent) were discharged without medication and 60 (33.1 percent) were transferred to the NICU for morphine treatment. Treatment rates were similar: 31 of 87 infants in the TAU group and 29 of 94 infants in the SVS group (35.6 percent vs 30.9 percent, respectively; p=0.60).

“Future studies are warranted to determine frequencies, durations, and timing to optimize the effect and ascertain the effectiveness of SVS as an alternative vs complementary treatment to pharmacotherapy,” the investigators said.