Related Experiment Video
Updated: Feb 16, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Prenatal Opioid Exposure and Intermittent Hypoxemia in Preterm Infants: A Retrospective Assessment
Elie G Abu Jawdeh1, Philip M Westgate2, Amrita Pant1
1Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States.
Insights
Prenatal opioid exposure is linked to increased intermittent hypoxemia (episodes of low oxygen) in preterm infants. This condition, characterized by drops in oxygen saturation, persists beyond the initial newborn period.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Intermittent hypoxemia (IH), defined as episodic drops in oxygen saturation (SpO2), poses risks to preterm infants due to immature respiratory control.
- Emerging evidence links IH to neonatal morbidities and long-term neurodevelopmental impairments.
- Understanding factors influencing IH in preterm infants is critical, especially given rising rates of prenatal opioid exposure.
Purpose of the Study:
- To investigate the relationship between isolated prenatal opioid exposure and intermittent hypoxemia (IH) in preterm infants.
- To assess the impact of maternal opioid use during pregnancy on neonatal respiratory outcomes.
Main Methods:
- Prospective collection of high-resolution SpO2 data in preterm infants (<30 weeks gestational age) for the first 8 weeks of life.
- Retrospective chart review for data on isolated prenatal opioid exposure, excluding tobacco or poly-drug use.
- Primary outcome: percent time with SpO2 < 80% (%time-SpO2 < 80); Secondary outcome: number of severe IH events/week (IH-SpO2 < 80).
Main Results:
- A total of 82 infants were analyzed (14 opioid-exposed, 68 unexposed); baseline characteristics were similar.
- Opioid-exposed infants showed a statistically significant increase in %time-SpO2 < 80 (mean difference 0.23, p=0.03).
- The number of severe IH events/week was higher in the opioid-exposed group (mean difference 2.95, p=0.08), though not statistically significant.
Conclusions:
- Preterm infants with prenatal opioid exposure exhibit increased measures of intermittent hypoxemia compared to unexposed infants.
- The heightened risk of IH associated with prenatal opioid exposure extends beyond the immediate postnatal period.
- These findings underscore the importance of monitoring respiratory status in preterm infants with prenatal opioid exposure.
Introduction:
Intermittent hypoxemia (IH) is defined as episodic drops in oxygen saturation (SpO2). Preterm infants are at increased risk for IH due to their immature respiratory control/apnea of prematurity. The clinical relevance of IH is a relatively new observation with rising evidence linking IH to neonatal morbidities and long-term impairment. Hence, assessing factors that influence IH in preterm infants is imperative. Given the epidemic of opioid misuse in the USA, there is an urgent need to understand the impact of prenatal opioid exposure on neonatal outcomes. Hence, we wanted to assess the relationship between isolated prenatal opioid exposure and IH in preterm infants.
Methods:
In order to accurately calculate IH, SpO2 data were prospectively collected using high-resolution pulse oximeters during the first 8 weeks of life in preterm infants less than 30 weeks gestational age. Data related to prenatal opioid misuse were retrospectively collected from medical charts. Infants with tobacco or poly-drug exposure were excluded. The primary outcome measure is percent time spent with SpO2 below 80% (%time-SpO2 < 80). The secondary outcome measure is the number of severe IH events/week with SpO2 less than 80% (IH-SpO2 < 80).
Results:
A total of 82 infants with isolated opioid exposure (n = 14) or who were unexposed (n = 68) were included. There were no significant differences in baseline characteristics between opioid exposed and unexposed groups. There was a statistically significant increase of 0.23 (95% CI: 0.03, 0.43, p = 0.03) in mean of the square root of %time-SpO2 < 80. The number of IH-SpO2 < 80 events was higher in the opioid exposed group (mean difference = 2.95, 95% CI: -0.35, 6.25, p-value = 0.08), although statistical significance was not quite attained.
Conclusion:
This study shows that preterm infants prenatally exposed to opioids have increased IH measures compared to unexposed infants. Interestingly, the increased IH in the opioid exposed group persists beyond the immediate postnatal period.
