Infants born with neonatal abstinence syndrome (NAS) had
significantly smaller head circumference than infants with no fetal exposure to
opioids, a researcher said here.
Mean head circumference was almost a full centimeter smaller
in infants born with NAS compared to controls (33.04 cm versus 33.99 cm,
respectively, P<0.001), reported Craig V. Towers, MD, of the University of
Tennessee Medical Center in Knoxville.
At a presentation at the Society for Maternal-Fetal
Medicine's Annual Pregnancy Meeting, Towers said that there have only been a
few retrospective studies examining the effect of NAS on head circumference,
and very limited prospective data on the subject.
He added that recently, a few smaller studies reported
smaller brain volumes and abnormal white matter development in older children
ages 9 to 14 treated for neonatal abstinence syndrome at birth.
Researchers therefore performed a prospective cohort study,
where cases were selected when a neonate ≥34 weeks was diagnosed and treated
for neonatal abstinence syndrome in the NICU. This was defined through a
Finnegan score (two consecutive scores of ≥10 or one ≥12). Controls were
matched for race, parity, mode of delivery and gestational age at delivery, and
control mothers did not have illicit substance use based on history and a urine
drug screen. All pregnancies were well-dated.
Use of illicit drugs, tobacco, alcohol, gabapentin,
anti-emetics and SSRIs were recorded in both cases and controls. Towers noted
that the control group had a median of three drug screens, while the cases had
a median of six drug screens.
Overall, 858 neonates were assessed -- 429 cases and
controls apiece. In addition to the smaller mean head circumference, many more
infants with NAS versus controls had head circumference at the 10th percentile
or less (30.1% versus 11.9%, respectively, P<0.0001) and the 3rd percentile
or less % (8.2% versus 1.9%, respectively, P<0.0001). In line with earlier
data, NICU length of stay was significantly longer for infants with neonatal
abstinence syndrome compared to controls (about 21 days versus around 3 days,
P<0.0001).
In most of the neonatal abstinence syndrome cases, mothers
were on opioid agonist medication-assisted treatment, with three-quarters on
buprenorphine, and 12% on methadone.
But in a multi-variate analysis, the authors found the only
significant risk factor for a smaller head circumference was opioid use in
pregnancy resulting in neonatal abstinence syndrome (adjusted OR 3.19, 95% CI
2.23-4.56) -- not any other drug or substance use.
At the presentation, Towers noted that recent guidelines
from the American College of Obstetricians and Gynecologists (ACOG) do not
recommend detoxification during pregnancy for managing opioid use disorder, and
questioned whether this should be revisited.
"Analyses of newborns delivered of mothers that undergo
opiate detoxification during pregnancy and deliver newborns without NAS are
needed to determine if the current recommended management of [opioid use
disorder] in pregnancy should be altered," he said.
Towers said further research is needed to determine if
neonates born with neonatal abstinence syndrome are at increased risk for
future neurologic dysfunction. He said his group is currently following a
cohort of these infants to try to help shed some light on this question.
"Hopefully, I'll be able to come back with follow-up on
these kids in 2 to 3 years to tell you how they're doing," he said.
https://www.medpagetoday.com/meetingcoverage/smfm/70958
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