Related Experiment Video
Updated: Aug 26, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
One-Year Neurodevelopmental Outcomes After Neonatal Opioid Withdrawal Syndrome: A Prospective Cohort Study
Kristen L Benninger1,2, Celine Richard3,4, Sara Conroy5,6
1Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, Columbus.
Insights
Infants treated for neonatal opioid withdrawal syndrome (NOWS) show lower 1-year neurodevelopmental outcomes. Early speech-language pathology referral is crucial for optimal development in these children.
Area of Science:
- Pediatric Neurodevelopment
- Neonatal Abstinence Syndrome Research
- Speech and Hearing Sciences
Background:
- Neonatal opioid withdrawal syndrome (NOWS) affects infants exposed to opioids in utero.
- Pharmacological treatment is common for NOWS, but long-term neurodevelopmental outcomes require further investigation.
- Understanding speech, language, hearing, and physical anomalies is critical for comprehensive care.
Purpose of the Study:
- To assess 1-year neurodevelopmental outcomes in children with NOWS.
- To specifically evaluate speech, language, and hearing development in this cohort.
- To determine the prevalence of cleft lip and/or cleft palate in infants with NOWS.
Main Methods:
- Prospective observational cohort study of 202 infants with confirmed in utero opioid exposure and pharmacological NOWS treatment.
- Standardized developmental assessments (Bayley-III or DAYC-2) administered at 1-year follow-up (80% follow-up rate).
- Comparison of scores to population norms; analysis of hearing evaluations and speech-language pathology referrals.
Main Results:
- Infants with NOWS demonstrated lower cognitive, language, and motor scores compared to population means at 1 year.
- One case of isolated cleft palate and Pierre Robin sequence was identified.
- While all passed newborn hearing screens, 7.5% had abnormal/inconclusive results on later evaluations, primarily due to middle ear effusion.
Conclusions:
- Pharmacologically treated NOWS is associated with significantly impaired neurodevelopmental outcomes at 1 year.
- A substantial percentage of infants require speech-language pathology services before age 2.
- Maternal mental health conditions were linked to lower language and motor scores in infants.
Purpose:
The aims of this study were, in a cohort of children with neonatal opioid withdrawal syndrome (NOWS), (a) to report 1-year neurodevelopmental outcomes and specifically characterize speech, language, and hearing outcomes and (b) to report the prevalence of cleft lip and/or cleft palate.
Method:
This prospective observational cohort study includes newborns with confirmed in utero opioid exposure who received pharmacological treatment for NOWS. During 1-year-old developmental visits, we administered standardized assessments (Bayley Scales of Infant and Toddler Development-Third Edition [Bayley-III] or Developmental Assessment of Young Children-Second Edition [DAYC-2]-due to COVID-19 restrictions). We compared Bayley-III scores to standardized population means using one-sample tests. We report estimates, 95% confidence intervals, and two-sided p values.
Results:
We enrolled 202 infants (October 2018 to March 2020). Follow-up at 1-year was 80%. Infants with NOWS had lower Bayley-III scores at 1 year compared to published norms for cognitive, language, and motor domains. One infant with NOWS was diagnosed with isolated cleft palate and Pierre Robin sequence. All infants passed the newborn hearing screen, and 7.5% had a formal hearing evaluation after neonatal intensive care unit discharge, with 40% having abnormal or inconclusive results; middle ear effusion was the leading cause of abnormal hearing (66.7%). Ten percent of children received a speech-language pathology referral prior to 2 years of age. Infants born to mothers with mental health conditions were more likely to have Bayley-III or DAYC-2 scores below 95 in language or motor domains.
Conclusions:
Infants with pharmacologically treated NOWS have significantly lower cognitive, language, and motor scores on standardized developmental testing compared to population means at 1 year of age. Early speech-language pathology referral is frequently necessary to promote optimal development in this population.
Supplemental Material:
https://doi.org/10.23641/asha.20044403.
More Related Videos
05:13Preclinical Model of Prenatal Delta-9-Tetrahydrocannabinol Exposure to Assess Its Impact on Neurodevelopmental Outcomes
Published on: February 28, 2025
09:29Investigating Drivers of Antireward in Addiction Behavior with Anatomically Specific Single-Cell Gene Expression Methods
Published on: August 4, 2022