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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Effects of polysubstance exposure on neonatal outcomes for infants with intrauterine opioid exposure

Corrie E McDaniel1,2, Matthew Test3,4, Parimal Deodhar3,4

  • 1Department of Pediatrics, University of Washington, Seattle, WA, USA. corrie.mcdaniel@seattlechildrens.org.

Journal of Perinatology : Official Journal of the California Perinatal Association
|July 10, 2020
PubMed

Insights

Prenatal polysubstance exposure, including methadone, prolonged infant hospital stays but did not worsen withdrawal symptoms or morphine needs. Most infants show peak withdrawal within 4 days.

Area of Science:

  • Neonatal Abstinence Syndrome
  • Pharmacology
  • Public Health

Background:

  • Prenatal exposure to substances, including methadone, can lead to Neonatal Abstinence Syndrome (NAS).
  • Understanding the impact of polysubstance exposure alongside methadone is crucial for optimizing neonatal care.
  • Current clinical guidelines for NAS management require further refinement based on specific substance exposures.

Purpose of the Study:

  • To quantify the impact of prenatal polysubstance exposure on neonatal outcomes compared to methadone-only exposure.
  • To compare time to maximum Finnegan scores, need for scheduled morphine, and length of stay (LOS) between groups.
  • To inform clinical practice regarding the observation and management of infants with prenatal substance exposure.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of 323 infants with prenatal substance exposure.
  • Comparison of outcomes between infants exposed to methadone-only versus methadone with additional psychoactive substances.

Main Results:

  • Median time to maximum Finnegan scores was 38.0 hours, with 94% peaking within 96 hours.
  • No significant difference in the proportion of infants requiring scheduled morphine (45% methadone-only vs. 54% polysubstance, p=0.10).
  • Polysubstance-exposed infants had a 1.30 times longer length of stay (LOS) (95% CI: 1.05, 1.60).

Conclusions:

  • Prenatal exposure to methadone with additional psychoactive substances is associated with a significantly longer LOS.
  • Polysubstance exposure did not correlate with increased postnatal morphine use or more severe peak withdrawal symptoms.
  • Most infants experience peak withdrawal symptoms within 4 days, suggesting that extended observation beyond this period may not be beneficial for all cases.
Abstract

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