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Letter to the editor

Journal of Perinatology volume 38, pages 1282–1283 (2018)Cite this article

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We thank Dr. Jones and her colleagues for their excellent points and appreciate their efforts to improve care and outcomes for opioid-exposed infants. We agree that a retrospective chart review is not the ideal study design to determine outcomes in children with neonatal abstinence syndrome (NAS). Many of the infants in our study were exposed to multiple substances in utero and had other adverse environmental exposures both in utero and postnatally, and these exposures likely confounded our findings. However, polysubstance exposure is unfortunately the reality of the current opioid epidemic, and our study is therefore generalizable to what many communities across the country are experiencing. In reply to the authors’ third point, as discussed in our paper, standardized protocols for NAS assessment, medication initiation, breastfeeding, and rooming in are used at all of our area hospitals, as all hospitals are staffed by the same group of physicians. Depending on the hospital, the choice of medication to treat NAS was different, although each medication was initiated and weaned based on a standardized protocol. We did not find differences in outcomes based on NAS treatment, but our sample size was likely not large enough to be able to evaluate differences in these different postnatal exposures.

We agree that Bayley Scale of Infant Development, Edition-3 (BSID-III) scores at 22–26 months of age are not perfect predictors of school-age outcomes. However, other studies have found effects of opioids on cognition and behavior at school age [1, 2]. The authors, in their recent study of preschool-age outcomes [3], found (as we did) that the mean Bayley score at 24 months of age was within 1 SD of the published normative mean of 100. Their cohort had a mean of 96.3 on the cognitive composite, 92.7 on the language composite, and 99.8 on the motor composite. Recent studies have suggested that the Bayley-III may significantly underestimate developmental delay [4, 5]. One study found that mean values of the general population are significantly higher than expected (between 0.55 and 1.23 SD above the normative mean [6]). Therefore, we have concerns that even though both their population and ours were performing “within the normal range,” that both of our studies could be underestimating the prevalence of developmental delay in opioid-exposed preschoolers.

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Authors and Affiliations

  1. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Stephanie L. Merhar, Jennifer M. McAllister, Kathryn E. Wedig-Stevie, Amy C. Klein, Jareen Meinzen-Derr & Brenda B. Poindexter

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  1. Stephanie L. Merhar
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  2. Jennifer M. McAllister
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Correspondence to Stephanie L. Merhar.

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Merhar, S.L., McAllister, J.M., Wedig-Stevie, K.E. et al. Letter to the editor. J Perinatol 38, 1282–1283 (2018). https://doi.org/10.1038/s41372-018-0176-x

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