Head circumference in infants with nonopiate-induced neonatal abstinence syndrome

Abstract

Background No relationship has been reported between nonopiate neonatal abstinence syndrome (NAS) and anthropometric indices, including head circumference (HC). The purpose of this study was to determine the relationship between maternal nonopioid drug use and HC at birth in neonates with NAS. Methods This retrospective observational study included neonates born between January 1, 2010 and March 31, 2019, whose mothers had been taking antipsychotic, antidepressant, sedative, or anticonvulsant medications. The outcome measures were HCs of NAS infants and controls. Results Of 159 infants, 33 (21%) were diagnosed with NAS. There was no maternal opioid use among mothers during pregnancy. The HCs in the NAS group were significantly smaller than those in the control group. The median z-scores for HC at birth were −0.20 and 0.29 in the NAS group and the control group, respectively (P = .011). The median HCs at birth were 33.0 and 33.5 cm in the NAS group and the control group, respectively. Multivariate analysis revealed that maternal antipsychotic drug use and selective serotonin reuptake inhibitors were independently associated with NAS (P < .001 and P = .004, respectively). Notably, benzodiazepine use and smoking were not independent risk factors. Conclusions The results suggest an association between maternal antipsychotic drug use and NAS, which was further associated with decreased HC. Careful monitoring of maternal drug use should be considered to improve fetal outcomes.

Prediction model for nonopiate‐induced neonatal abstinence syndrome

“…Exclusion criteria were as follows: (i) gestation shorter than 36 weeks; (ii) for infants: birthweight <2000 g; (iii) for mothers: drugs taken only before conception; (iv) for mothers: anticonvulsants taken alone; and (v) for infants: chromosomal abnormalities, congenital heart disease, and respiratory disorders. This is the same dataset used in our previous study, 4 and because that study reported that anticonvulsants alone did not cause NAS, anticonvulsants were excluded in this study.…”

“…Clinical symptoms include irritability, apnea, involuntary movements, seizures, tachycardia, sweating, vomiting, and diarrhea, sometimes requiring intensive care 2 . Opioid‐induced NAS is common worldwide but psychiatric drugs are a more common cause in Japan 3,4 …”

“…In recent years, the prevalence of psychiatric‐complicated pregnancies has remained at approximately 3% 5,6 . The prevalence of nonopiate‐induced NAS is not well understood but it is thought to be lower than that of opiate‐induced NAS 4,7–9 . However, the risk of developing NAS may result in longer hospital stays than usual.…”

“…hypnotic use. 4 This study was approved by the Okayama University ethics committee, was conducted using the opt-out method via the website (No. 1907-040), and followed the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis reporting guidelines.…”

The immediate and long-term effects of prenatal opioid exposure

“…Emerging data demonstrate the adverse effects of prenatal opioid exposure on the developing brain at the macrostructural, microstructural, neurophysiological, and/or functional levels. In utero opioid exposure results in a smaller head circumference (e.g., altered brain growth), although this effect may be mediated by co-exposure to maternal tobacco or other psychoactive medications ( 44 , 61 – 64 ). Early studies using ultrasonography have shown enlargement of in the thalamus of exposed subjects over the first six months of life ( 65 , 66 ).…”