Prenatal Exposures Are Associated With Worse Neurodevelopmental Outcomes in Infants With Neonatal Opioid Withdrawal Syndrome

Kristen L Benninger; Teresa Borghese; Jason B Kovalcik; Melissa Moore-Clingenpeel; Cherie Isler; Elizabeth M Bonachea; Ann R Stark; Stephen W Patrick; Nathalie L Maitre

doi:10.3389/fped.2020.00462

Prenatal Exposures Are Associated With Worse Neurodevelopmental Outcomes in Infants With Neonatal Opioid Withdrawal Syndrome

Front Pediatr. 2020 Aug 27:8:462. doi: 10.3389/fped.2020.00462. eCollection 2020.

Authors

Affiliations

¹ Department of Pediatrics and Neonatology, Nationwide Children's Hospital, Columbus, OH, United States.
² Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States.
³ Biostatistics Core, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States.
⁴ Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
⁵ Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States.
⁶ Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.

Abstract

Aim: To define a developmental trajectory in infants with neonatal opioid withdrawal syndrome (NOWS) and determine whether the impacted developmental domain varies with the type of antenatal exposure. Methods: We performed a retrospective cohort study of infants treated pharmacologically for NOWS and assessed using a standardized schedule for follow-up visits. We compared outcomes of the study population to published norms using one-sample t-tests. Multivariable models examined associations with exposures in addition to opioids. Results: In our cohort of 285 infants with 9-12-months testing, 164 (55.7%) were seen at 3-4 months, and 125 (44%), at 15-18 months. The majority (58%) had intrauterine drug exposures in addition to opioids. Neurodevelopmental scores of infants with NOWS at 3-4 and 9-12 months were not different from published norms. Cognitive and language scores at 15-18 months were worse than published norms. Male sex, older maternal age, and additional barbiturate or alcohol exposure were associated with worse outcomes. Conclusion: Infants with pharmacologically treated NOWS had development similar to unexposed infants during the 1st year but worse cognitive and language scores during the 2nd year. These data support the need for a prospective follow-up of large cohorts of infants with NOWS, with systematic assessments and an evaluation of contributing factors.

Keywords: in utero exposure; neonatal abstinence syndrome; neonatal opioid withdrawal syndrome; neurodevelopment; opioid.