Persistent feeding difficulties among infants with fetal opioid exposure: mechanisms and clinical reasoning

Hart, Brandon; Viswanathan, S.; Jadcherla, Sudarshan R.

doi:10.1080/14767058.2018.1469614

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…Motor outcomes were assessed in 18 studies in this age group ( 30 – 34 , 36 , 44 , 45 , 48 , 49 , 66 , 69 , 70 , 81 , 94 , 95 , 99 , 105 ). Motor development was mainly assessed at birth, among infants and toddlers (3–4 days to 3 years old).…”

Section: Resultsmentioning

confidence: 99%

Prenatal exposure to opioids and neurodevelopment in infancy and childhood: A systematic review

et al. 2023

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AimThis systematic review aims to estimate the relationship between prenatal exposure to opioids and neurodevelopmental outcomes and examines potential sources of heterogeneity between the studies.MethodsWe searched four databases through May 21st, 2022: PubMed, Embase, PsycInfo and the Web of Science according to a specified search strings. Study inclusion criteria include: (1) cohort and case-control peer-reviewed studies published in English; (2) studies comparing neurodevelopmental outcomes among children with prenatal opioid-exposure (prescribed or used non-medically) vs. an unexposed group. Studies investigating fetal alcohol syndrome or a different primary prenatal exposure other than opioids were excluded. Two main performed data extraction using “Covidence” systematic review platform. This systematic review was conducted in accordance with PRISMA guidelines. The Newcastle-Ottawa-Scale was used for quality assessment of the studies. Studies were synthesized based on the type of neurodevelopmental outcome and the instrument used to assess neurodevelopment.ResultsData were extracted from 79 studies. We found significant heterogeneity between studies due to their use of different instruments to explore cognitive skills, motor, and behavioral outcomes among children of different ages. The other sources of heterogeneity included: procedures to assess prenatal exposure to opioids; period of pregnancy in which exposure was assessed; type of opioids assessed (non-medical, medication used for opioid use dis-order, prescribed by health professional), types of co-exposure; source of selection of prenatally exposed study participants and comparison groups; and methods to address lack of comparability between exposed and unexposed groups. Cognitive and motor skills as well as behavior were generally negatively affected by prenatal opioid exposure, but the significant heterogeneity precluded a meta-analysis.ConclusionWe explored sources of heterogeneity in the studies assessing the association between prenatal exposure to opioids and neurodevelopmental outcomes. Sources of heterogeneity included different approaches to participant recruitment as well as exposure and outcome ascertainment methods. Nonetheless, overall negative trends were observed between prenatal opioid exposure and neuro-developmental outcomes.

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Section: Resultsmentioning

confidence: 99%

Prenatal exposure to opioids and neurodevelopment in infancy and childhood: A systematic review

et al. 2023

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“…35 Feeding difficulties and GERD are also more common in infants with NAS. 12 Because opioid receptors are concentrated in the CNS and gastrointestinal tract, withdrawal symptoms causing gastrointestinal dysfunction are common. 36 Abnormal modulation of the central and enteric nervous system has been demonstrated to cause esophageal dysmotility and aero-digestive issues in infants.…”

Section: Discussionmentioning

confidence: 99%

“…36 Abnormal modulation of the central and enteric nervous system has been demonstrated to cause esophageal dysmotility and aero-digestive issues in infants. 37 A study by Hart et al 12 examined pharyngo-esophageal manometry in infants with in-utero opioid exposure compared to healthy controls and found lower esophageal sphincter dysfunction in infants with NAS consistent with upregulation of central vagal effects, heightened cholinergic response, and inadequate foregut relaxation. It is possible that a common pathway involving GERD symptoms and/or feeding difficulties could account for the association between NAS and LM, however further studies are needed to confirm this speculation.…”

Section: Discussionmentioning

confidence: 99%

“…Newborn esophageal reflux was also included in the regression model due to its previously-described association with LM. 12 Multicollinearity was measured by variance inflation factor (VIF). A VIF of less than 5 was considered to be permissible for inclusion in the regression model.…”

Section: Methodsmentioning

confidence: 99%

“…Mechanistically, there is evidence this could be due to neurogenic causes or gastric reflux disease, as this is also more common in infants with NAS. 12 This is relevant as theoretically, adequately treating the withdrawal symptoms may improve symptoms of LM and may affect future clinical decision making.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Neonates With Laryngomalacia and Neonatal Abstinence Syndrome

Abraham

Danis

Levi

2021

Ann Otol Rhinol Laryngol

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Objective: Laryngomalacia (LM) is the most common congenital anomaly of the larynx. The cause of LM is still largely unknown, but a neurological mechanism has gained the most acceptance. There have not been any studies examining the prevalence of LM in infants with Neonatal Abstinence Syndrome (NAS). The aim of our study is to determine if infants with NAS are more likely to be diagnosed with LM. Methods: This study was a population-based inpatient registry analysis. We examined nationwide neonatal discharges in 2016 using the Kids’ Inpatient Database (KID). Only patients listed as neonates were included. The International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1) and diagnoses denoting LM were used. To quantify associations between the LM and NAS groups, prevalence rates and odds ratios (ORs) were used. Results: There were 3 970 065 weighted neonatal discharges in the 2016 KID. Among patients included in our dataset, 0.809% (32 128) had NAS and 0.075% (2974) had LM. There was an increased odds ratio for neonates with NAS and LM (OR of 2.85, 95% CI = 2.24-3.63) compared to infants without NAS. Multiple logistic regression accounting for possible confounders produced an adjusted OR of 1.68 (95% CI = 1.29-2.19). Conclusion: Our study found an association between NAS and LM. This suggests that prenatal exposure to opioids or possibly the sequelae of withdrawal symptoms may be risk factors for the development of LM.

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Otolaryngologic conditions in children with neonatal abstinence syndrome: A descriptive study

Naimi¹,

Wang²,

Jaleel³

et al. 2023

American Journal of Otolaryngology

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Persistent feeding difficulties among infants with fetal opioid exposure: mechanisms and clinical reasoning

Cited by 11 publications

References 24 publications

Prenatal exposure to opioids and neurodevelopment in infancy and childhood: A systematic review

Prenatal exposure to opioids and neurodevelopment in infancy and childhood: A systematic review

Association Between Neonates With Laryngomalacia and Neonatal Abstinence Syndrome

Otolaryngologic conditions in children with neonatal abstinence syndrome: A descriptive study

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