Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.
JAMA Pediatr. 2021 Jul 1;175(7):706-714. doi: 10.1001/jamapediatrics.2020.6364.
Knowledge of health outcomes among opioid-exposed infants is limited, particularly for those not diagnosed with neonatal opioid withdrawal syndrome (NOWS).
To describe infant mortality among opioid-exposed infants and identify how mortality risk differs in opioid-exposed infants with and without a diagnosis of NOWS compared with infants without opioid exposure.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of maternal-infant dyads was conducted, linking health care claims with vital records for births from January 1, 2010, to December 31, 2014, with follow-up of infants until age 1 year (through 2015). Maternal-infant dyads were included if the infant was born in Texas at 22 to 43 weeks' gestational age to a woman aged 15 to 44 years insured by Texas Medicaid. Data analysis was performed from May 2019 to October 2020.
The primary exposure was prenatal opioid exposure, with infants stratified by the presence or absence of a diagnosis of NOWS during the birth hospitalization.
Risk of infant mortality (death at age <365 days) was examined using Kaplan-Meier and log-rank tests. A series of logistic regression models was estimated to determine associations between prenatal opioid exposure and mortality, adjusting for maternal and neonatal characteristics and clustering infants at the maternal level to account for statistical dependence owing to multiple births during the study period.
Among 1 129 032 maternal-infant dyads, 7207 had prenatal opioid exposure, including 4238 diagnosed with NOWS (mean [SD] birth weight, 2851 [624] g) and 2969 not diagnosed with NOWS (mean [SD] birth weight, 2971 [639] g). Infant mortality was 20 per 1000 live births for opioid-exposed infants not diagnosed with NOWS, 11 per 1000 live births for infants with NOWS, and 6 per 1000 live births in the reference group (P < .001). After adjusting for maternal and neonatal characteristics, mortality in infants with a NOWS diagnosis was not significantly different from the reference population (odds ratio, 0.82; 95% CI, 0.58-1.14). In contrast, the odds of mortality in opioid-exposed infants not diagnosed with NOWS was 72% greater than the reference population (odds ratio, 1.72; 95% CI, 1.25-2.37).
In this study, opioid-exposed infants appeared to be at increased risk of mortality, and the treatments and supports provided to those diagnosed with NOWS may be protective. Interventions to support opioid-exposed maternal-infant dyads are warranted, regardless of the perceived severity of neonatal opioid withdrawal.
关于阿片类药物暴露婴儿的健康结果的知识有限，特别是对于那些没有被诊断为新生儿阿片类药物戒断综合征（NOWS）的婴儿。
描述阿片类药物暴露婴儿的死亡率，并确定与没有阿片类药物暴露的婴儿相比，患有和不患有 NOWS 的阿片类药物暴露婴儿的死亡率风险有何不同。
设计、地点和参与者：对 2010 年 1 月 1 日至 2014 年 12 月 31 日期间德克萨斯州医疗补助保险产妇-婴儿对进行了回顾性队列研究，通过关键记录对来自德克萨斯州 22 至 43 周妊娠期、年龄在 15 至 44 岁之间的产妇-婴儿对进行了链接，并对婴儿进行了随访至 1 岁（至 2015 年）。如果婴儿是在德克萨斯州出生，胎龄为 22 至 43 周，母亲年龄在 15 至 44 岁之间，并且母亲是德克萨斯州医疗补助保险的参保人，则将产妇-婴儿对纳入研究。数据分析于 2019 年 5 月至 2020 年 10 月进行。
主要暴露是产前阿片类药物暴露，根据婴儿在出生住院期间是否存在 NOWS 诊断，将婴儿分层。
使用 Kaplan-Meier 和对数秩检验来检查婴儿死亡率（<365 天死亡）的风险。估计了一系列逻辑回归模型，以确定产前阿片类药物暴露与死亡率之间的关联，同时调整了产妇和新生儿的特征，并通过将婴儿聚类到产妇水平来考虑由于研究期间多次分娩而导致的统计依赖性。
在 1129032 对产妇-婴儿对中，有 7207 对有产前阿片类药物暴露，其中 4238 对被诊断为 NOWS（出生体重平均[SD]为 2851[624]g），2969 对未被诊断为 NOWS（出生体重平均[SD]为 2971[639]g）。未被诊断为 NOWS 的阿片类药物暴露婴儿的死亡率为每 1000 例活产 20 例，患有 NOWS 的婴儿的死亡率为每 1000 例活产 11 例，参考组的死亡率为每 1000 例活产 6 例（P<0.001）。在调整了产妇和新生儿特征后，NOWS 诊断婴儿的死亡率与参考人群无显著差异（比值比，0.82；95%CI，0.58-1.14）。相比之下，未被诊断为 NOWS 的阿片类药物暴露婴儿的死亡风险比参考人群高 72%（比值比，1.72；95%CI，1.25-2.37）。
在这项研究中，阿片类药物暴露的婴儿似乎有更高的死亡风险，而对那些被诊断为 NOWS 的婴儿提供的治疗和支持可能具有保护作用。无论新生儿阿片类药物戒断的严重程度如何，都需要对支持阿片类药物暴露的产妇-婴儿对进行干预。
