Infant Mortality Associated With Prenatal Opioid Exposure

Area of Science:

• Perinatal Health
• Neonatal Outcomes
• Public Health

Background:

• Limited knowledge exists on health outcomes for opioid-exposed infants, especially those without a neonatal opioid withdrawal syndrome (NOWS) diagnosis.
• Infant mortality rates and risk factors among opioid-exposed infants require further investigation.

Purpose of the Study:

• To determine infant mortality rates in opioid-exposed infants.
• To compare mortality risk between opioid-exposed infants with and without NOWS and infants without opioid exposure.

Main Methods:

• Retrospective cohort study linking Texas Medicaid claims and vital records (2010-2014, 1-year infant follow-up).
• Included maternal-infant dyads with infants born in Texas (22-43 weeks gestation).
• Analyzed infant mortality risk using Kaplan-Meier, log-rank tests, and logistic regression, adjusting for covariates.

Main Results:

• Among 1,129,032 dyads, 7,207 had prenatal opioid exposure.
• Infant mortality rates: 20/1000 for NOWS-undiagnosed, 11/1000 for NOWS-diagnosed, and 6/1000 for unexposed infants (P < .001).
• Adjusted analysis showed no significant mortality difference for NOWS-diagnosed infants (OR, 0.82; 95% CI, 0.58-1.14), but a 72% increased risk for NOWS-undiagnosed infants (OR, 1.72; 95% CI, 1.25-2.37).

Conclusions:

• Opioid-exposed infants have an elevated risk of mortality.
• NOWS diagnosis and associated treatments/supports may offer protection.
• Interventions are recommended for all opioid-exposed maternal-infant dyads, irrespective of withdrawal severity.