Association between prenatal opioid exposure, neonatal opioid withdrawal syndrome, and neurodevelopmental and behavioral outcomes at 5–8 months of age

Abstract

Background: While use of prescription opioids and medication assisted therapy (MAT) for opioid use disorder in pregnancy, as well as the prevalence of neonatal opioid withdrawal syndrome (NOWS) continue to rise, little is known about outcomes for children with NOWS beyond the newborn period. Methods: We examined 1) prenatal MAT exposure vs. unexposed healthy controls [HC]; and 2) treatment for NOWS and NOWS severity on infant neurodevelopmental and behavioral outcomes at 5–8 months of age in 78 maternal-infant pairs from the ENRICH prospective cohort study. Data were obtained from 3 study visits: prenatal, delivery, and neurodevelopmental evaluation at 5–8 months of age. Neurodevelopmental outcomes included the Bayley Scales of Infant Development [BSID-III], caregiver questionnaires (Parenting Stress Index [PSI-SF], Infant Behavior Questionnaire [IBQ-R], Sensory Profile), and the experimental Still-Face Paradigm (SFP). Results: No differences in the BSID-III, PSI-SF, or IBQ-R scores were observed between MAT groups and HC; however, MAT-exposed and HC infants differed with respect to SFP self-regulation (β=−18.9; p=0.01) and Sensory Profile sensation seeking (OR=4.87; 95% CI: 1.55; 15.30) after adjusting for covariates. No significant differences between Treated-for-NOWS vs. not-Treated-for-NOWS were observed. Shorter timing to NOWS treatment initiation was associated with higher Total Stress (β=−9.08; p=0.035), while longer hospitalization was associated with higher Parent-child dysfunction (p=0.018) on PSI-SF. Conclusions: Our results provide additional evidence of little-to-no effect of MAT and pharmacological treatment of NOWS on infant neurodevelopmental and behavioral outcomes at 5–8 months of age. However, prolonged hospitalization might increase family psychosocial stress and requires further examination.

Perinatal fentanyl exposure leads to long-lasting impairments in somatosensory circuit function and behavior

“…Adolescent children prenatally exposed to opioids may exhibit lasting somatosensory deficits (Kivistö et al, 2015) that may be independent of the expression of NOWS (Bakhireva et al, 2019). Adaptation, the cessation of a paw withdrawal response, to repeated stimuli is a key measure of sensory processing.…”

Cognitive and Behavioral Impact on Children Exposed to Opioids During Pregnancy

“…However, compared with healthy controls, a higher proportion of neonates born to mothers on MAT had negative affect and self-regulation, and fewer demonstrated typical performance in the sensation-seeking scale. 46 Beckwith and Burke 42 compared 28 infants with in utero opioid exposure with a historical control and found significant differences in the Bayley Scales of Infant and Toddler Development, Third Edition cognitive, language, and motor subscales. The authors of another study examined the outcomes of children whose mothers had received methadone and buprenorphine in pregnancy and found that at 36 months, the children were within normal range on multiple instruments in cognition, sensory processing, and behavior, although there was no control group.…”

Early life opioid exposure and potential long-term effects

“…Very few studies have assessed for behavioral outcomes in NOWS infants. In a cohort of 5–8 month olds, Bakhireva et al (2019) reported higher negative affect and lower self-regulation in NOWS infants versus healthy controls. NOWS infants were also more likely to be rated as ‘sensation seeking’, i.e., are more likely to search for additional sensory stimulation via oral (biting/mouthing) or physical (touching) means.…”