Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield, MA, USA.
Department of Pediatrics, Tufts Medical Center, Boston, MA, USA.
J Neonatal Perinatal Med. 2021;14(4):463-473. doi: 10.3233/NPM-200615.
Increasing rates of maternal opioid use disorder has led to greater number of opioid exposed newborns (OENs). Maternal enrollment in medication for opioid use disorder (MOUD) program improves short term neonatal outcomes. This study aimed at assessing neurobehavioral outcomes for OENs.
Retrospective observational cohort study of OENs between Jul 2006 and Dec 2018. Two study groups were identified as initiation of medication for opioid use disorder (MOUD) prior to diagnoses of pregnancy or after. Primary outcome variables were enrollment in and duration of EI services. Secondary outcome variable was diagnoses of a behavioral and/or developmental disorder (BDD) during the study period.
Of 242 infants, 113 were enrolled in EI and BDD diagnoses data was available for all infants [age range 6 to 12 years], 82% infants had exposure to maternal MOUD, while 18% were exposed to either maternal prescription non-MOUD opioids or illicit opioids. Maternal MOUD initiation prior to pregnancy was associated with improved short term outcomes for OENs. Almost a third of infants were diagnosed with a BDD with no differences between the two study groups.
Early initiation of maternal MOUD improved short term outcomes and discharge disposition for OENs. Prolonged in-utero exposure to opioids presents a potential for negative impact on neurodevelopmental and behavioral outcomes. These risks must be considered to increase access and adherence to EI services, as well as to focus on non-opioid based maternal MOUD. Longitudinal studies assessing the safety of MOUD on short and long-term child health outcomes are needed.
产妇阿片类药物使用障碍的发生率不断上升，导致越来越多的阿片类药物暴露新生儿（OEN）。产妇参加阿片类药物使用障碍药物治疗（MOUD）项目可改善短期新生儿结局。本研究旨在评估 OEN 的神经行为结局。
对 2006 年 7 月至 2018 年 12 月期间 OEN 的回顾性观察队列研究。确定了两个研究组，分别为在妊娠诊断前或妊娠后开始使用 MOUD。主要结局变量为 EI 服务的参与和持续时间。次要结局变量为在研究期间诊断为行为和/或发育障碍（BDD）。
在 242 名婴儿中，113 名婴儿接受了 EI 服务，所有婴儿（年龄 6 至 12 岁）均有 BDD 诊断数据，82%的婴儿暴露于母体 MOUD，而 18%的婴儿暴露于母体处方非 MOUD 阿片类药物或非法阿片类药物。在妊娠前开始使用母体 MOUD 与 OEN 的短期结局改善相关。近三分之一的婴儿被诊断患有 BDD，两组之间无差异。
早期开始母体 MOUD 可改善 OEN 的短期结局和出院安置。在子宫内长期暴露于阿片类药物可能对神经发育和行为结局产生负面影响。必须考虑这些风险，以增加获得 EI 服务的机会并提高其依从性，并关注非阿片类药物为主的母体 MOUD。需要进行评估 MOUD 对短期和长期儿童健康结局安全性的纵向研究。
