Delivery timing for the opioid-exposed infant.

Area of Science:

• Neonatalogy
• Obstetrics
• Pharmacology

Background:

• Increasing prevalence of opioid use disorder (OUD) and medication-assisted treatment (MAT) in pregnancy.
• Preterm infants show lower incidence of neonatal opioid withdrawal syndrome (NOWS) compared to term infants.
• Uncertainty exists regarding the impact of early term delivery on NOWS risk.

Purpose of the Study:

• To compare neonatal outcomes in opioid-exposed infants born at early, full, and late-term gestational periods.
• Investigate the association between delivery timing and neonatal morbidity in OUD pregnancies.
• Evaluate the effect of gestational age at birth on the incidence and severity of NOWS.

Main Methods:

• Retrospective cohort study of opioid-exposed pregnancies (≥37 weeks gestation) from 2010-2017.
• Exclusion of multiple gestations and fetal anomalies.
• Defined maternal opioid exposure and primary composite neonatal outcome including respiratory distress, sepsis, seizures, HIE, jaundice, low Apgar, NICU admission, NOWS, or death.

Main Results:

• No significant differences in the primary composite outcome or incidence/severity of NOWS between early, full, and late-term groups.
• High rates of neonatal morbidity observed, with 74.2% experiencing NOWS and 54.9% requiring NICU admission.
• Pharmacologic NOWS treatment was needed for 40.1% of neonates, averaging nearly 3 weeks.

Conclusions:

• Neonatal morbidity is frequent in opioid-exposed neonates, regardless of delivery timing.
• Incidence and severity of NOWS and other neonatal outcomes did not differ between early, full, and late-term deliveries.
• Opioid-exposed infants may not benefit from early term delivery; current practices should be reconsidered.