Neonatal abstinence syndrome: Neurobehavior at 6 weeks of age in infants with or without pharmacological treatment for withdrawal

Heller, Nicole E.; Logan, Beth A.; Morrison, Deborah G.; Paul, Jonathan A.; Brown, Mark S.; Hayes, Marie J.

doi:10.1002/dev.21532

Cited by 28 publications

(21 citation statements)

References 45 publications

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“…Opioid and other drug exposure during pregnancy can alter neonatal neurobehavioral and physiological responses to stimuli as measured by the NICU Network Neurobehavioral Scales (5,6). Exposed infants display dysregulated behavior, high levels of stress/abstinence, and have difficulty modulating arousal, all of which can impair infants' interaction with caregivers and the environment (5)(6)(7). Neurobehavioral functioning among exposed infants typically improves during the 1st month of life, but stress and abstinence symptoms are still present in exposed infants at 6 weeks of age (5,6).…”

Section: Introductionmentioning

confidence: 99%

Prenatal Exposures Are Associated With Worse Neurodevelopmental Outcomes in Infants With Neonatal Opioid Withdrawal Syndrome

et al. 2020

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Aim: To define a developmental trajectory in infants with neonatal opioid withdrawal syndrome (NOWS) and determine whether the impacted developmental domain varies with the type of antenatal exposure. Methods: We performed a retrospective cohort study of infants treated pharmacologically for NOWS and assessed using a standardized schedule for follow-up visits. We compared outcomes of the study population to published norms using one-sample t-tests. Multivariable models examined associations with exposures in addition to opioids. Results: In our cohort of 285 infants with 9-12-months testing, 164 (55.7%) were seen at 3-4 months, and 125 (44%), at 15-18 months. The majority (58%) had intrauterine drug exposures in addition to opioids. Neurodevelopmental scores of infants with NOWS at 3-4 and 9-12 months were not different from published norms. Cognitive and language scores at 15-18 months were worse than published norms. Male sex, older maternal age, and additional barbiturate or alcohol exposure were associated with worse outcomes. Conclusion: Infants with pharmacologically treated NOWS had development similar to unexposed infants during the 1st year but worse cognitive and language scores during the 2nd year. These data support the need for a prospective follow-up of large cohorts of infants with NOWS, with systematic assessments and an evaluation of contributing factors.

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Section: Introductionmentioning

confidence: 99%

Prenatal Exposures Are Associated With Worse Neurodevelopmental Outcomes in Infants With Neonatal Opioid Withdrawal Syndrome

et al. 2020

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“…The RICHS cohort, however, consists of healthy, full-term infants from a population with higher socioeconomic status than many studies of prenatal stress focus on. Much of the prior work on NNNS scores and prenatal stress, outside of this cohort, has focused on women experiencing severe stressors such as drug use and treatment ( 35 , 36 ). Therefore, mothers in the RICHS population may not be exposed to sufficient stressors to see the changes identified in infant outcomes.…”

Section: Discussionmentioning

confidence: 99%

Prenatal exposure to maternal depression and anxiety on imprinted gene expression in placenta and infant neurodevelopment and growth

et al. 2018

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BackgroundDepression and/or anxiety during pregnancy have been associated with impaired fetal growth and neurodevelopmental. Because placental imprinted genes play a central role in fetal development and respond to environmental stressors, we hypothesized that imprinted gene expression would be affected by prenatal depression and anxiety.MethodsPlacental gene expression was compared between mothers with prenatal depression and/or anxiety/obsessive compulsive disorder/panic and control mothers without psychiatric history (n=458) in the Rhode Island Child Health Study.ResultsTwenty-nine genes were identified as being significantly differentially expressed between placentae from infants of mothers with both depression and anxiety (n=54), with depression (n=89), or who took perinatal psychiatric medications (n=29) and control mother/infant pairs, with most genes having decreased expression in the stressed group. Among placentae from infants of mothers with depression, we found no differences in expression by medication use, indicating that our results are related to the stressor rather than the treatments. We did not find any relationship between the stress-associated gene expression and neonatal neurodevelopment as measured using the Neonatal Intensive Care Unit Network Neurobehavioral Scale.ConclusionsThis variation in expression may be part of an adaptive mechanism by which the placenta buffers the infant from the effects of maternal stress.

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“…This study should be interpreted with caution, however, given that infants were assessed at a mean age of 55 days, when it is difficult to capture variability in language and cognition using the Bayley. Heller et al (2017) examined differences in neurodevelopmental outcome using the NNNS among 6-week old infants with prenatal methadone exposure who did ( n = 23) or did not ( n = 16) require pharmacological treatment for NOWS compared to a demographically matched control group ( n = 21; Heller et al, 2017 ). Infants who were exposed to methadone and who required treatment had more difficulty self-regulating and had poorer quality movement compared to an unexposed control and compared to infants who were exposed but did not require treatment ( Heller et al, 2017 ).…”

Section: Prenatal Opioid Exposure Effects On Genetic Epigenetic Andmentioning

confidence: 99%

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

Conradt

Crowell

Lester

2018

Neurobiology of Stress

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Prenatal opioid exposure has reached epidemic proportions. In the last 10 years, there has been a 242% increase in the number of babies born with the drug withdrawal syndrome known as Neonatal Opioid Withdrawal Syndrome (NOWS). Developmental outcome studies of infants with prenatal opioid exposure are limited by methodological issues including small sample sizes and lack of control for confounding variables such as exposure to poverty and maternal psychopathology. Thus, there is a critical gap in the literature that limits our ability to predict short-term effects of opioid exposure. Here we review direct neurotoxic, indirect, and stress-related pathophysiologies of prenatal opioid exposure. We describe the literature on short and long-term neurodevelopmental outcomes of children with prenatal opioid exposure, highlighting sex differences and the role of early life stress. We conclude by prioritizing avenues for future research for this group of underserved women and their children at risk for neurodevelopmental delays.

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Neonatal abstinence syndrome: Neurobehavior at 6 weeks of age in infants with or without pharmacological treatment for withdrawal

Cited by 28 publications

References 45 publications

Prenatal Exposures Are Associated With Worse Neurodevelopmental Outcomes in Infants With Neonatal Opioid Withdrawal Syndrome

Prenatal Exposures Are Associated With Worse Neurodevelopmental Outcomes in Infants With Neonatal Opioid Withdrawal Syndrome

Prenatal exposure to maternal depression and anxiety on imprinted gene expression in placenta and infant neurodevelopment and growth

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

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