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Characteristics and outcomes of neonatal opioid withdrawal syndrome in preterm infants: a retrospective cohort study in the current era

Journal of Perinatology volume 43, pages 909–915 (2023)Cite this article

Subjects

Abstract

Objective

Compare Neonatal Opioid Withdrawal Syndrome (NOWS) in preterm and term infants.

Study design

Single center, retrospective chart review of all in-utero opioid exposed infants born between 2014 and 2019. Withdrawal symptoms were assessed using Modified Finnegan Assessment Tool.

Results

Thirteen preterm (PT), 72 late preterm (LPT), and 178 term infants were included. Preterm and LPT compared to term infants had lower peak Finnegan scores (9/9 vs. 12) and received less pharmacologic treatment (23.1/44.4 vs. 66.3%). Similar onset, peak symptoms, and treatment duration was observed in LPT and term infants.

Conclusions

Preterm and LPT infants have lower Finnegan scores and require less pharmacologic therapy for NOWS. It is unclear if this is because our current assessment tool does not capture their symptoms or if they truly have less withdrawal. Onset of NOWS is similar in LPT and term infant, thus LPT infants do not require prolonged hospital monitoring for NOWS.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Strahan AE, Guy GP, Bohm M, Frey M, Ko JY. Neonatal abstinence syndrome incidence and health care costs in the United States, 2016. JAMA Pediatr. 2020;174:200–2. https://doi.org/10.1001/jamapediatrics.2019.4791.

    Article  PubMed  Google Scholar 

  2. Sutter MB, Leeman L, Hsi A. Neonatal opioid withdrawal syndrome. Obstet Gynecol Clin North Am. 2014 ;41:317–34. https://doi.org/10.1016/j.ogc.2014.02.010.

    Article  PubMed  Google Scholar 

  3. Jasson LM, Velez M. Neonatal abstinence syndrome. Curr Opin Pediatr. 2012;24:252–8.

    Article  Google Scholar 

  4. Stover MW, Davis JM. Opioids in pregnancy and neonatal abstinence syndrome. Semin Perinatol. 2015;39:561–5. https://doi.org/10.1053/j.semperi.2015.08.013.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Doberczak T, Kandal S, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatrics. 1991;118:933–7.

    Article  CAS  Google Scholar 

  6. Dysart K, Hsieh H, Kaltenbach K, Greenspan J. Sequela of preterm versus term infants born to mothers on a methadone maintenance program: Differential course of neonatal abstinence syndrome. J Perinat Med. 2007;35:344–6. https://doi.org/10.1515/JPM.2007.063.

    Article  CAS  PubMed  Google Scholar 

  7. Allocco E, Melker M, Rojas-Miguez F, Bradley C, Hahn KA, Wachman EM. Comparison of neonatal abstinence syndrome manifestations in preterm versus term opioid-exposed infants. Adv Neonatal Care. 2016;16:329–36.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ruwanpathirana R, Abdel-Latif ME, Burns L, Chen J, Craig F, Lui K, et al. Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome. Acta Paediatr. 2015;104:e188–94. https://doi.org/10.1111/apa.12910.

    Article  CAS  PubMed  Google Scholar 

  9. Gibson KS, Stark S, Kumar D, Bailit JL. The relationship between gestational age and the severity of neonatal abstinence syndrome. Addiction. 2017;112:711–6. https://doi.org/10.1111/add.13703.

    Article  PubMed  Google Scholar 

  10. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. REDCap Consortium, The REDCap consortium: Building an international community of software partners, J Biomed Inform. 2019 May https://doi.org/10.1016/j.jbi.2019.103208.

  11. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42:377–81.

    Article  Google Scholar 

  12. American Addiction Centers. Polysubstance Use and Misuse: The Unique Treatment Needs of Polydrug Users. [Internet]. Brentwood, TN [Updated 2022 June 02; cited 2022 Jan 3]. Available from: https://americanaddictioncenters.org/polysubstance-abuse

  13. Alcohol and Drug Foundation. Polydrug Use. [Internet]. North Melbourne, Victoria. [Updated 2021 Nov 26; cited 2022 Jan 3]. Available from: https://adf.org.au/reducing-risk/polydrug-use/

  14. Software: IBM SPSS Statistics for Windows [software], Version 27.0. Armonk, NY: IBM Corp. https://www.ibm.com/analytics/spss-statistics-software

  15. Patrick SW, Barfield WD, Poindexter BD, Committee On Fetus and Newborn, Committee on Substance Use and Prevention, Cummings J, et al. Neonatal Opioid Withdrawal Syndrome. Pediatrics November 2020;146:e2020029074. https://doi.org/10.1542/peds.2020-029074

  16. Hudak ML, Tan RC. Committee on drugs, committee on fetus and newborn, american academy of pediatrics: neonatal drug withdrawal. Pediatrics. 2012;129:e540–60.

    Article  PubMed  Google Scholar 

  17. Isemann B, Meinzen-Derr J, Akinbi H. Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome. J Perinatol. 2011;31:25–9. https://doi.org/10.1038/jp.2010.66.

    Article  CAS  PubMed  Google Scholar 

  18. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134:e547–61.

    Article  PubMed  Google Scholar 

  19. Smyser CD, Inder TE, Shimony JS, Hill JE, Degnan AJ, Snyder AZ, et al. Longitudinal analysis of neural network development in preterm infants. CerebCortex. 2010;20:2852–62.

    Google Scholar 

  20. Crapnell TL, Rogers CE, Neil JJ, Inder TE, Woodward LJ, Pineda RG. Factors associated with feeding difficulties in the very preterm infant. Acta Paediatr. 2013;102:e539–45. https://doi.org/10.1111/apa.12393.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Finnegan LP, Kron LE, Connaughton JF, Emich JP. A Scoring System for evaluation and treatment of the neonatal abstinence syndrome, a clinical research tool. Basic and Therapeutic aspects of perinatal pharmacology. New York: Raven Press. 1975

  22. Finnegan LP, Connaughton JF Jr, Kron RE, Emich JP. Neonatal abstinence syndrome: Assessment and management. Addict Dis. 1975;2:141–58.

    CAS  PubMed  Google Scholar 

  23. Armbruster D, Schwirian C, Mosier A, Tam WM, Prusakov P. Neonatal abstinence syndrome and preterm infants: a look at current practice. Adv Neonatal Care. 2021;21:107–14. https://doi.org/10.1097/ANC.0000000000000858.

    Article  PubMed  Google Scholar 

  24. Devlin LA, Breeze JL, Terrin N, Gomez-Pomar E, Bada H, Finnegan LP, et al. Association of a simplified finnegan neonatal abstinence scoring tool with the need for pharmacologic treatment for neonatal abstinence syndrome. JAMA Netw Open. 2020;3:e202275. https://doi.org/10.1001/jamanetworkopen.2020.2275.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Weller AE, Crist RC, Reiner BC, Doyle GA, Berrettini WH. Neonatal opioid withdrawal syndrome (NOWS): a transgenerational echo of the opioid crisis. Cold Spring Harb Perspect Med 2021;11:a039669 https://doi.org/10.1101/cshperspect.a039669.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Lester BM, Kosofsky B. Effects of drugs of abuse on brain development. Neurobiology of mental illness. 3rd edition. New York: Oxford University Press; 2009.

  27. McPherson C, Grunau RE. Neonatal pain control and neurologic effects of anesthetics and sedatives in preterm infants. Clin Perinatol. 2014;41:209–27. https://doi.org/10.1016/j.clp.2013.10.002.

    Article  PubMed  Google Scholar 

  28. Quesada O, Gotman N, Howell HB, Funai EF, Rounsaville BJ, Yonkers KA. Prenatal hazardous substance use and adverse birth outcomes. J Matern-Fetal Neonatal Med. 2012;8:1222–7. https://doi.org/10.3109/14767058.2011.602143.

    Article  Google Scholar 

  29. Almario CV, Seligman NS, Dysart KC, Berghella V, Baxter JK. Risk factors for preterm birth among opiate-addicted gravid women in a methadone treatment program. Am J Obstet Gynecol. 2009;201:326.e1–6.

    Article  PubMed  Google Scholar 

  30. Gillogley KM, Evans AT, Hansen RL, Sameuls SJ, Batra KK. The perinatal impact of cacine, amphetamine, and opiate use detected by universal intrapartum screening. Am J Obstet Gynecol. 1990;163:1535–42.

    Article  CAS  PubMed  Google Scholar 

  31. American College of Obstetricians and Gynecologists. Opioid abuse, dependence, and addiction in pregnancy. Comm Opin No 524 Obstet Gynecol. 2012;119:1070–6.

    Google Scholar 

  32. Patrick SW, Davis MM, Lehmann CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol. 2015;35:650–5. https://doi.org/10.1038/jp.2015.36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank—Michele Walsh for helping inspire the concept for this project; as well as Leslie Clark and Abigail Gibbs for contributions and assistance during this project. This research project was funded the Fellows Research Awards Programs provided by the Rainbow Babies & Children’s Foundation. Grant support from Clinical and Translational Science Award allowed for the utilizations of REDCap.

Author information

Authors and Affiliations

  1. Division of Neonatology, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH, USA

    Alicia Heyward, Anna Maria Hibbs & Moira Crowley

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Alicia Heyward, Nori Minich, Adriana C. Hoffman, Anna Maria Hibbs & Moira Crowley

  3. Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH, USA

    Nori Minich & Adriana C. Hoffman

  4. Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Lulu Zhao

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Contributions

AH, MC and LZ contributed to the conception and design of this study. AH and ACH completed the data collection. NM completed data analysis. AH, MC and AMH contributed to data analysis interpretation. AH wrote the first draft of the manuscript, with all authors revising it critically for important intellectual content. All authors approved the final version to be published.

Corresponding author

Correspondence to Alicia Heyward.

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Competing interests

The authors declare no competing interests.

Ethics approval

All components of this research project adhered to the intuition’s research guidelines and ethical standards. This study was approved by the University Hospitals Institutional Review Board.

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Heyward, A., Minich, N., Hoffman, A.C. et al. Characteristics and outcomes of neonatal opioid withdrawal syndrome in preterm infants: a retrospective cohort study in the current era. J Perinatol 43, 909–915 (2023). https://doi.org/10.1038/s41372-023-01672-x

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