Rana Divya, Gaston Kan P, DeBaer Linda, Pourcyrous Massroor
Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee.
Am J Perinatol. 2025 May;42(7):891-898. doi: 10.1055/a-2437-0828. Epub 2024 Oct 29.
This study aimed to evaluate the impact of in-utero illicit fentanyl exposure on neonatal outcomes, including neonatal opioid withdrawal syndrome (NOWS), length of stay (LOS), and treatment requirements.This study was conducted from March 2020 to December 2022, and focused on neonates born to mothers with opioid use or opioid use disorder (OUD). Maternal opioid use was identified through self-report or umbilical cord tissue (UCT) testing. Severe NOWS was defined as cases requiring pharmacological treatment. Statistical analyses included univariate comparisons, logistic regression, and generalized linear models to assess the associations between fentanyl exposure and neonatal outcomes.Forty-seven percent (75/159) of infants had in-utero fentanyl exposure. Fentanyl-positive mothers were older, 31 ± 5 years, compared to non-fentanyl mothers, 29 ± 5, = 0.01. They were also less likely to receive prenatal care ( < 0.01) and had a higher number of polysubstance used, 5 ± 1 compared to non-fentanyl mothers, 3 ± 1, < 0.01. Overall, infants exposed to fentanyl had a higher incidence of severe NOWS (odds ratio = 5.8, 95% confidence interval [CI]: 2.49-12.95, < 0.01) and required earlier NOWS treatment initiation, 1 ± 1 day compared to non-exposed infants 3 ± 2 days, < 0.01. In adjusted analysis, fentanyl exposure was associated with a nearly three-fold increased risk of NOWS (Mantel-Haenszel combined relative risk = 2.98, 95% CI: 1.94-4.57). Furthermore, fentanyl exposure led to longer LOS, with a 40% increase for preterm neonates ( < 0.01) and a 63% increase for full-term neonates ( < 0.01). Additionally, there was a significant correlation between log fentanyl concentration in umbilical cord tissue and cumulative morphine dose required for NOWS treatment, = 0.001.Prenatal illicit fentanyl exposure is an independent and strong risk factor for severe NOWS presentation in newborns requiring extended hospital stays. · Illicit fentanyl is increasingly recognized as a major driver of opioid-related substance use disorders during pregnancy, often occurring alongside polysubstance use.. · Significant prenatal exposure to opioids is a well-established risk factor for neonatal opioid withdrawal syndrome. The recent rise in illicit fentanyl use has heightened these concerns.. · Both preterm and term infants are at risk for severe withdrawal symptoms following prenatal exposure to illicit fentanyl..
本研究旨在评估子宫内非法芬太尼暴露对新生儿结局的影响，包括新生儿阿片类药物戒断综合征（NOWS）、住院时间（LOS）和治疗需求。本研究于2020年3月至2022年12月进行，重点关注阿片类药物使用或阿片类药物使用障碍（OUD）母亲所生的新生儿。通过自我报告或脐带组织（UCT）检测确定母亲的阿片类药物使用情况。严重NOWS定义为需要药物治疗的病例。统计分析包括单变量比较、逻辑回归和广义线性模型，以评估芬太尼暴露与新生儿结局之间的关联。47%（75/159）的婴儿有子宫内芬太尼暴露。芬太尼检测呈阳性的母亲年龄较大，为31±5岁，而非芬太尼母亲为29±5岁，P = 0.01。她们接受产前护理的可能性也较小（P < 0.01），并且使用的多种物质数量较多，为5±1种，而非芬太尼母亲为3±1种，P < 0.01。总体而言，暴露于芬太尼的婴儿严重NOWS的发生率较高（优势比 = 5.8，95%置信区间[CI]：2.49 - 12.95，P < 0.01），并且需要更早开始NOWS治疗，为1±1天，而非未暴露婴儿为3±2天，P < 0.01。在调整分析中，芬太尼暴露与NOWS风险增加近三倍相关（Mantel - Haenszel合并相对风险 = 2.98，95% CI：1.94 - 4.57）。此外，芬太尼暴露导致住院时间延长，早产新生儿增加40%（P < 0.01），足月新生儿增加63%（P < 0.01）。此外，脐带组织中芬太尼浓度对数与NOWS治疗所需的累积吗啡剂量之间存在显著相关性，P = 0.001。产前非法芬太尼暴露是需要延长住院时间的新生儿严重NOWS表现的独立且强大的风险因素。·非法芬太尼越来越被认为是孕期阿片类药物相关物质使用障碍的主要驱动因素，常与多种物质使用同时发生。·产前大量暴露于阿片类药物是新生儿阿片类药物戒断综合征的既定风险因素。近期非法芬太尼使用的增加加剧了这些担忧。·早产和足月婴儿在产前暴露于非法芬太尼后都有出现严重戒断症状的风险。
