Engagement With Recommended Developmental Follow-up and Supports Among Infants With Intrauterine Opioid Exposure

Describe the engagement of opioid-exposed infants (OEI) with recommended developmental surveillance and supports in the first year of life.

We conducted a single-site retrospective cohort study of OEI delivered between 2016 and 2021, linking birth hospitalization, developmental follow-up (DFU) clinic, and early intervention (EI) records. Primary outcomes were attendance at DFU clinic and evaluation by EI. We used multivariable modified Poisson regression to examine how birthing parent-, infant-, and clinic-level factors are associated with service engagement.

Of 256 OEI, 75% engaged in at least 1 developmental service. Referral and attendance rates at the DFU clinic were 69% and 33%, respectively. Ninety-three percent were referred to EI, 73% evaluated and 58% enrolled in services. EI evaluation was positively associated with prolonged infant hospitalization (adjusted risk ratio [aRR] 1.01; CI, 1.002-1.01) and exposure to antidepressants (aRR 1.23; CI, 1.02-1.49) and cocaine (aRR 1.28; CI, 1.09-1.50). Probability of attendance at DFU was higher for infants born to parents receiving care at an integrated perinatal substance use clinic (aRR 2.13; CI, 1.07-4.24) and exposed to antipsychotics (aRR 1.73; CI, 1.12-2.67), whereas those remaining in parental custody had lower probability of engagement (aRR 0.62; CI, 0.39-0.97).

Three-quarters of the OEI engaged in developmental surveillance services in the first year of life. Factors relating to disease severity, location of birthing parent care, birthing parent co-exposures, and parental custody were associated with engagement. Efforts to improve engagement in recommended follow-up should elicit the perspectives of caregivers to better understand the mechanisms that drive these differences.