Autonomic Nervous System Function Following Prenatal Opiate Exposure

Abstract

In utero exposure to opiates may affect autonomic functioning of the fetus and newborn. We investigated heart rate variability (HRV) as a measure of autonomic stability in prenatal opiate-exposed neonates (n = 14) and in control term infants (n = 10). Electrocardiographic data during both non-nutritive and nutritive sucking were evaluated for RR intervals, heart rate (HR), standard deviation of the consecutive RR intervals (SDRR), standard deviation of the differences of consecutive RR intervals (SDDRR), and the power spectral densities in low and high frequency bands. In controls, mean HR increased significantly, 143–161 per min (p = 0.002), with a trend toward a decrease in RR intervals from non-nutritive to nutritive sucking; these measures did not change significantly among exposed infants. Compared to controls, exposed infants demonstrated significantly greater HRV or greater mean SDRR and SDDRR during non-nutritive period (p < 0.01), greater mean SDDRR during nutritive sucking (p = 0.02), and higher powers in the low and high frequency bands during nutritive feedings. Our findings suggest that prenatal opiate exposure may be associated with changes in autonomic nervous system (ANS) functioning involving both sympathetic and parasympathetic branches. Future studies are needed to examine the effects of prenatal opiate exposure on ANS function.

Autonomic nervous system development and its impact on neuropsychiatric outcome

“…Specific children at increased risk include those with a history of prematurity and other neonatal conditions, such as congenital heart disease, fetal growth restriction, neonatal abstinence syndrome, and maternal stress/neuropsychiatric illness. (12–15) For example, adults born preterm are at increased risk for mental health disorders including anxiety, depression, and reduced social engagement. (11) Fetal and maternal epigenetic mechanisms likely contribute to the risk for depression, bipolar disorder, and schizophrenia in these early-life conditions.…”

Early life stress and environmental influences on the neurodevelopment of children with prenatal opioid exposure

“…For example, fetuses exposed to buprenorphine ( n = 6) showed higher fetal heart rate variability, more accelerations in fetal heart rate, and greater coupling between heart rate and movement in the second trimester compared to methadone-exposed fetuses ( n = 11), and in the third trimester fetuses exposed to buprenorphine exhibited more motor activity ( Jansson et al, 2011 , Jansson et al, 2017 ). After birth, newborns with prenatal opioid exposure also exhibited greater heart rate variability during nutritive and non-nutritive sucking compared to non-exposed controls ( Hambleton et al, 2013 ).…”

The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its’ Origins, Assessment, and Management

“…Timing of presentation of NAS is usually within the first 72 h of life but it can occur as late as 7 days of life ( 27 , 38 ). Signs of NAS can be classified in: (a) neurologic manifestations due to increased excitability, including tremors, excessive and/or high pitch cry, hyperactive Moro, increased muscle tone, seizures; (b) gastrointestinal manifestations include diarrhea, vomiting, uncoordinated sucking, and swallowing; and (c) autonomic manifestations include fever, sweating, nasal stuffiness, and increased respiratory rate ( 25 , 27 , 37 , 40 , 43 , 44 ). The most common signs are related to the neurologic and gastrointestinal manifestations, however, there is variability in the presentation of signs among neonates ( 27 , 38 , 40 , 45 ).…”

“…Another concern is at which point the non-pharmacological interventions alone will have deleterious effects on the neurological development of infants with NAS. Infants with antenatal opiate exposure will have an increased noradrenergic activity, among other neurological abnormalities, once they are born and the opiate supply ceases ( 32 , 43 , 72 , 73 ). Therefore, we question that not offering pharmacological treatment is enough for these infants and could be detrimental in the long term.…”