P0223 - Childhood Morbidity After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis

Background
Neonatal abstinence syndrome (NAS) has been declared a national crisis in the USA. Given this surge in incidence and the frequent co-existence of adverse childhood experiences in this population it is essential to gain insight into the future health and wellbeing of this population.

Objective
To systematically review and meta-analyse the association between NAS and adverse health or educational outcomes.

Data sources
A search strategy was developed in Medline Ovid and adapted for 11 databases. An all-language search was conducted across 11 databases between January 1, 1975, and September 3, 2019.

Study selection
Cohort studies and case series of children between 28 days and 16 years of age, in whom a diagnosis of opiate-related NAS was documented, were included. Exclusion criteria were studies of children prenatally exposed to opiates but without NAS, studies of iatrogenic NAS, and studies not focusing on opiate-related NAS.

Data Extraction and Synthesis
Of 5865 studies identified, 581 full-text articles were screened for eligibility, independently by three reviewers, and data from 15 studies were extracted. Data were pooled using a random-effects model and presented as crude and adjusted Odds Ratios (aOR).
Main Outcome(s) and Measure(s): Health and educational outcomes including: incidence of childhood diagnoses, reasons for hospital admissions, indicators of neurodevelopmental outcomes and indicators of academic attainment up to 16 years of age.

Results
Fifteen studies were included, five of which were suitable for meta-analyses. This comprised 10,907 children with previous NAS and 1,730,213 children without previous NAS, aged 0-16 years. There was a strong association between NAS and: subsequent child maltreatment (aOR 6.49 (4.46, 9.45, I2=52%)) and injuries and poisoning (aOR 1.34 (1.21, 1.49, I2= 0%)). Neglect was the commonest type of reported maltreatment. Studies consistently demonstrated increased incidence of mental health conditions, visual problems and speech and language impairment amongst those with previous NAS. Children with NAS also had lower mean academic scores than controls in every domain of testing across age groups.

Conclusions
We highlight that a diagnosis of NAS is a flag for future childhood risk of maltreatment, injuries and poisoning, mental health diagnoses, speech and language impairment and visual impairment. We hypothesize that these associations are underpinned by disproportionate exposure to adverse childhood experiences. However, due to incomplete reporting amongst studies and likely unadjusted confounding, this review does not suggest causation. These are important issues for redress to prevent future child maltreatment, mitigate population health disparities, and to help improve the health trajectories of this growing population of children.