Racial differences in opioid withdrawal syndrome among neonates with intrauterine opioid exposure.

BACKGROUND: The aim of this study was to investigate the association between race and severe neonatal opioid withdrawal syndrome (NOWS) in infants exposed to intrauterine opioids. METHODS: This is a prospective observational study on intrauterine opioid-exposed term infants. Exposure to opioids was based on maternal disclosure, urine, or umbilical cord drug screening. Severe NOWS was defined based on modified Finnegan scoring and the need for pharmacological intervention. RESULTS: One hundred and fifty mother-infant pairs, 60 Black and 90 White with history of opioid exposure during pregnancy, were included. More White than Black infants developed NOWS that required pharmacological treatment, 70 vs. 40%: RR = 1.75 (1.25-2.45). In adjusted analysis, there was no significant association between race and the development of severe NOWS in mothers who attended opioid maintenance treatment program (OMTP). However, in mothers who did not attend OMTP, White race remained a significant factor associated with the development of severe NAS, RR = 1.69 (1.06, 2.69). CONCLUSIONS: Severe NOWS that required pharmacological intervention was significantly higher in White than in Black infants born to mothers who did not attend OMTP. Larger studies are needed to evaluate the association between social as well as genetic factors and the development of NOWS. IMPACT: There is a significant association between race and development of severe NOWS.

Narcotic-exposed neonates in a First Nations population in northwestern Ontario: incidence and implications.

OBJECTIVE: To document the incidence of neonatal abstinence syndrome (NAS) and the rate of narcotic use during pregnancy in northwestern Ontario, where narcotic abuse is a growing social and medical problem. DESIGN: Retrospective chart review. SETTING: The Sioux Lookout Meno Ya Win Health Centre catchment area in northwestern Ontario. PARTICIPANTS: Mothers and neonates for the 482 live births that took place in the 18-month study period (January 2009 to June 2010). MAIN OUTCOME MEASURES: Maternal drug use and neonatal outcomes were documented. RESULTS: The incidence of narcotic (oxycodone) abuse during pregnancy increased from a low of 8.4% at the beginning of the study period to a high of 17.2% by mid-2010. Narcotic-using mothers were more likely to also use nicotine and alcohol, to have premature deliveries, and to be episodic users. Narcotic-exposed neonates experienced NAS 29.5% of the time; daily maternal use was associated with a higher rate of NAS (66.0%). While all infants roomed in with their mothers, exposed infants were more likely to require transfer to a tertiary care nursery. Infants with severe NAS were treated with oral morphine and had significantly longer hospital stays compared with the entire cohort (4.5 vs 1.5 days, P = .004). Narcotic abuse during pregnancy in our region is not currently associated with increased rates of HIV or hepatitis C infection, as intravenous route of administration is less common at present than intranasal and oral ingestion. CONCLUSION: Narcotic abuse during pregnancy is a considerable problem in First Nations communities in northwestern Ontario. Community-based initiatives need to be developed to address this issue, and medical and nursing staff need to develop surveillance, assessment, and therapeutic responses. Passive neonatal addiction and withdrawal result from maternal narcotic use during pregnancy. Rates of opioid use among pregnant Canadian women are unknown.

Pregnancy and neonatal characteristics of opioid-dependent Indigenous Australians: a rural and metropolitan comparison.

AIMS: To identify maternal, obstetric and neonatal characteristics of opioid-dependent Indigenous Australians in rural and metropolitan settings. METHODS: Retrospective cohort study of 232 metropolitan and 67 rural infants born to mothers maintained on methadone throughout pregnancy for the treatment of opiate dependency, between January 2000 and December 2006. Medical records of identified mother/infant dyads were reviewed by evaluating 20 different maternal, obstetric and neonatal parameters. RESULTS: The number of infants of opiate-dependent mothers (IODMs) identified to be of Aboriginal ethnicity was 47 in the rural and 50 in the metropolitan setting. This reflected a significantly higher proportion in the rural versus metropolitan areas (70.1% vs 21.6%, P < 0.05). The effect of rurality was independent of ethnicity with significantly lower rates of neonatal withdrawal requiring treatment (P < 0.001), antenatal consultations (P < 0.01), department of community services (DoCS) involvement (P < 0.001) and shorter infant lengths of stay (P < 0.001). There was a non-significant trend towards more intrauterine growth restriction in Aboriginal infants. There were no significant differences in parameters in rural Indigenous versus rural non-Indigenous infants. CONCLUSIONS: Significant differences exist between rural and metropolitan IODMs in terms of less attendance at antenatal consultations, less neonatal withdrawal requiring treatment, shorter average length of hospital stay for the infant and less documented DoCS involvement. These differences maybe a reflection of a different diagnostic and management approach. Ethnicity had no major clinical impact in either the rural or the metropolitan settings. Future research comparing the long-term outcomes would be of interest.

Research and policy priorities for addressing prenatal exposure to opioids in Alaska.

The current opioid crisis in Alaska and the USA will negatively affect the health and wellbeing of future generations. The increasing number of infants born with neonatal opioid withdrawal syndrome (NOWS) has had a profound impact on families, health care providers and the child welfare system. This manuscript summarises the main themes of a Symposium held in Anchorage, Alaska with health care providers, researchers, elders and public health officials that focused on identifying emerging challenges, trends and potential solutions to address the increasing number of infants and children affected by maternal opioid use. Five areas of importance for research and policy development that would direct improvement in the care of infants with NOWS in Alaska are outlined with the goal of supporting a research agenda on opioid misuse and child health across the circumpolar north. Abbreviations: NOWS - neonatal opioid withdrawal syndrome; NAS - neonatal abstinence syndrome; MAT - medication-assisted treatment; NICU - neonatal intensive care unit; OATs - opioid agonist treatments; OCS - office of children's services; ANTHC - Alaska Native Tribal Health Consortium; OUD - opioid use disorder; SBIRT - screening, brief intervention and referral to treatment; ISPCTN - IDeA States Pediatric Clinical Trials Network; NIH - National Institutes of Health; ANMC - Alaska Native Medical Center; DHSS - Department of Health and Social Services; AAPP - All Alaska Pediatric Partnership.

Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome.

OBJECTIVE: To determine if racial differences are associated with Neonatal Opioid Withdrawal Syndrome (NOWS) severity. STUDY DESIGN: A 10-year (2008-2017) retrospective cohort of infants ≥35 weeks gestation with prenatal exposure to opioids was included. The primary measure was the need for pharmacotherapy. Multivariable logistic regression and propensity score analysis were performed. RESULTS: Among 345 infants with NOWS, 111 (32%) were black infants with 70% of them requiring pharmacotherapy as compared with 84% of white infants. Upon adjusting for significant covariates (methadone, benzodiazepine use, and gestational age), black infants were 57% less likely than whites to require pharmacotherapy (Odds ratio: 0.43, 95%CI: 0.22-0.80, p = 0.009). Similar results were observed with propensity score analysis. CONCLUSIONS: Significant racial disparity observed may be secondary to genetic variations in opioid pharmacogenomics and/or extrinsic factors. Large-scale studies are warranted to include race in predictive models for early pharmacological intervention.

Increasing prevalence of neonatal withdrawal syndrome: population study of maternal factors and child protection involvement.

OBJECTIVES: Illicit drug use during pregnancy is an important public health issue, with adverse effects on the newborn and implications for subsequent parenting. The aim of this study was to measure the birth prevalence of neonatal withdrawal syndrome over time, associated maternal characteristics and child protection involvement. METHODS: This is a retrospective cohort study that used linked health and child protection databases for all live births in Western Australia from 1980 to 2005. Maternal characteristics and mental health-and assault-related medical history were assessed by using logistic regression models. RESULTS: The birth prevalence of neonatal withdrawal syndrome increased from 0.97 to a high of 42.2 per 10 000 live births, plateauing after 2002. Mothers with a previous mental health admission, low skill level, Aboriginal status or who smoked during pregnancy were significantly more likely to have an infant with neonatal withdrawal syndrome. These infants were at greater risk for having a substantiated child maltreatment allegation and entering foster care. Increased risk for maltreatment was associated with mothers who were aged <30 years, were from socially disadvantaged backgrounds, Aboriginal status, and had a mental health-or assault-related admission. CONCLUSIONS: There has been a marked increase in neonatal withdrawal syndrome in the past 25 years. Specific maternal characteristics identified should facilitate planning for early identification and intervention for these women. Findings demonstrate an important pathway into child maltreatment and highlight the need for well-supported programs for women who use illicit drugs during pregnancy as well as the need for sustained long-term support after birth.