Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis

Rees, Philippa; Stilwell, Philippa Anna; Bolton, Chrissy; Akillioglu, Merve; Carter, Ben; Gale, Chris; Sutcliffe, Alastair

doi:10.1016/j.jpeds.2020.07.013

Cited by 14 publications

(18 citation statements)

References 55 publications

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“…infants born preterm, multiple births, extremely low birthweight infants, and other risk factors) 16,18 . While most studies found higher rates of cognitive impairment and behavior problems and lower school/academic performance after IUDE, reports of motor outcomes after IUDE are limited 4,5,8,9,11 …”

Section: Discussionmentioning

confidence: 99%

“…According to the 2019 National Survey on Drug Use and Health, 5.8% of pregnant females reported using illicit substances, 9.6% using tobacco products, and 9.5% drinking alcohol in the month before survey collection 1 . Substance use during pregnancy can have significant short‐ and long‐term health consequences for exposed infants 2–4 . With increasing evidence for the long‐term effects of intrauterine drug exposure (IUDE), developmental surveillance to improve trajectories is critical 5 .…”

mentioning

confidence: 99%

“…Most studies of neurological development after IUDE focus on cognitive and behavioral outcomes 4,5,8 . A few studies suggested a higher incidence of motor problems after IUDE (e.g.…”

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confidence: 99%

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Intrauterine drug exposure as a risk factor for cerebral palsy

Benninger

Purnell

Conroy

et al. 2021

Develop Med Child Neuro

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IUDE Intrauterine drug exposure NICU Neonatal intensive care unit NOWS Neonatal opioid withdrawal syndrome AIM To determine whether infants with intrauterine drug exposure (IUDE) are similarly at risk for cerebral palsy (CP) as other high-risk populations, whether CP classification differs based on IUDE status, and describe the association of CP with specific substances among exposed infants. METHOD This was a retrospective analysis of infants in a high-risk follow-up program (n=5578) between January 2014 and February 2018 with a history of IUDE or who received a CP diagnosis. CP rates were compared using two-sample z-tests. CP classification was assessed using Fisher's exact, Cochran-Armitage, and Wilcoxon rank-sum tests. Models for CP risk were assessed using multivariable logistic regression.RESULTS Among all infants with IUDE (n=1086), 53.8% were male with a mean (SD) birth gestational age of 36.8 (3.6) weeks. Among unexposed infants with CP (n=259), 54.4% were male with a mean (SD) birth gestational age of 29.9 (5.7) weeks. Opioids were the most common exposure (93.7%) of all infants with IUDE. The CP rate in the IUDE (5.2%) and unexposed (5.7%) high-risk populations were not significantly different (p=0.168), nor were there differences in CP typology, topography, or severity between exposed (n=57) and unexposed (n=259) infants (all p>0.05). In patients with IUDE and after controlling for established CP risk factors, the observed odds of CP varied among substances.INTERPRETATION We suggest that IUDE should be considered a 'newborn-detectable risk' in the guidelines for the early detection of CP.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Intrauterine drug exposure as a risk factor for cerebral palsy

Benninger

Purnell

Conroy

et al. 2021

Develop Med Child Neuro

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“…An increasing number of studies suggest that POE, as a result of both illegally obtained and prescribed opioids, is associated with long-term adverse developmental outcomes. Results from four recent meta-analyses, summarizing over 50 studies, consistently demonstrate worse outcomes for children with POE (Andersen et al 2020;Lee et al 2020;Rees et al 2020;Yeoh et al 2019). Developmental domains affected include cognition, language, motor function, socio-emotional skills and visual deficiencies such as strabismus and nystagmus.…”

Section: Developmental Healthmentioning

confidence: 97%

“…Developmental domains affected include cognition, language, motor function, socio-emotional skills and visual deficiencies such as strabismus and nystagmus. For example, meta-analytic evidence examining the impact of POE (due to OAT or illegally obtained opioids) on cognitive outcomes concluded that children exposed to opioids prenatally are three times more likely to have a severe intellectual disability (Andersen et al 2020;Lee et al 2020;Rees et al 2020;Yeoh et al 2019). However, many studies had important limitations (e.g., small sample sizes, observational designs) and differences in study characteristics (e.g., type of opioid exposure, age of assessment), making it difficult to draw definitive conclusions about the direct effect of opioid exposure.…”

Section: Developmental Healthmentioning

confidence: 99%

Reviewing the Evidence on Prenatal Opioid Exposure to Inform Child Development Policy and Practice

Camden¹,

Harris²,

Otter-Moore³

et al. 2021

hcq

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Prenatal opioid use is increasingly common and can have adverse impacts on maternal and child health. In Ontario, there are no clear guidelines or universal programs to support the healthy development of children with prenatal opioid exposure. We present the epidemiology of prenatal opioid exposure in Ontario, summarize research examining child health outcomes with a focus on child development, review emerging guidelines for child health and developmental surveillance and highlight promising programs. We emphasize the need to strengthen current Canadian recommendations for routine enhanced developmental and vision screening and ensure funding for evidence-based integrated maternal/child services.

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Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood

Lee,

Schofield,

Dronavalli

et al. 2024

JAMA Pediatr

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ImportanceChildren exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain.ObjectiveTo evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years.Design, Setting, and ParticipantsThis was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n = 5946) and intrauterine exposure to drugs of addiction (n = 1260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n = 202 098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n = 1 611 351). Data were analyzed from July 2001 to December 2021.Main OutcomesMain outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care.ResultsOf the 1 820 655 live births, 935 807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1 = A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90 433/209 304 [43.4%] vs 616 425/1 611 351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02.Conclusion and RelevanceChildren who were exposed to substance use during pregnancy incurred more hospital costs than children who were not exposed up to 20 years of age, but this was reduced in association with any contact with out-of-home care. This provides insights into possible strategies for reducing health and financial burdens associated with exposure to substance use during pregnancy for children.

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Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis

Cited by 14 publications

References 55 publications

Intrauterine drug exposure as a risk factor for cerebral palsy

Intrauterine drug exposure as a risk factor for cerebral palsy

Reviewing the Evidence on Prenatal Opioid Exposure to Inform Child Development Policy and Practice

Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood

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