Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome



To determine if racial differences are associated with Neonatal Opioid Withdrawal Syndrome (NOWS) severity.

Study design

A 10-year (2008–2017) retrospective cohort of infants ≥35 weeks gestation with prenatal exposure to opioids was included. The primary measure was the need for pharmacotherapy. Multivariable logistic regression and propensity score analysis were performed.


Among 345 infants with NOWS, 111 (32%) were black infants with 70% of them requiring pharmacotherapy as compared with 84% of white infants. Upon adjusting for significant covariates (methadone, benzodiazepine use, and gestational age), black infants were 57% less likely than whites to require pharmacotherapy (Odds ratio: 0.43, 95%CI: 0.22–0.80, p = 0.009). Similar results were observed with propensity score analysis.


Significant racial disparity observed may be secondary to genetic variations in opioid pharmacogenomics and/or extrinsic factors. Large-scale studies are warranted to include race in predictive models for early pharmacological intervention.

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We would like to thank our multidisciplinary team at the University of Maryland Medical center, including nurses, nurse practitioners, and physicians who are constantly involved in taking care of these patients. We would also like to thank Ms. Kelly Tracey in helping us identify patients for this review.

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Correspondence to Abhinav Parikh.

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Parikh, A., Gopalakrishnan, M., Azeem, A. et al. Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome. J Perinatol 39, 1370–1376 (2019). https://doi.org/10.1038/s41372-019-0440-8

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