Nutrition, Growth, and Breast Milk Utilization in Children with a History of Neonatal Opioid Withdrawal Syndrome

Background: There is increasing incidence of Neonatal Opioid Withdrawal Syndrome (NOWS) in the United States. In Ohio in 2017, the rate of NOWS was 10.7 per 1000 infant hospitalizations. In 2015 a multidisciplinary clinic was formed to ensure close follow-up for the unique needs of infants born with NOWS in our region through the first 3 years of life. Despite the substantial benefits of breast milk feedings, including improved hospital outcomes with NOWS, provision of breast milk is low in this population. Furthermore, NOWS is associated with intrauterine growth restriction and subsequent feeding difficulties, yet is little data surrounding nutrition, growth, and long-term breastfeeding rates in this population.

Methods: We performed a retrospective cohort study of infants from birth through 3 years seen in the NOWS follow-up clinic at Cincinnati Children’s Hospital Medical Center (CCHMC) from 2016-2019. Appropriate descriptive statistics were used for categorical and continuous variables.

Results: This study includes 962 individual patients seen in a total of 2596 patient encounters at the NOWS follow-up clinic. In total, 8% of patients received some form of human milk. Caregivers reported that infants were taking human milk at only 4% of all patient encounters. In encounters with formula-fed infants, 57% received a standard Ohio Women, Infants, and Children (WIC) federally contracted formula/milk, 18% received a low-lactose non-standard formula/milk, 7% received a soy or plant-based formula/milk, 4% received a semi-elemental formula, 2% received an elemental formula, and 8% received a higher calorie formula/milk. Of encounters with anthropometric data, 27% had a weight percentile for age below the 10th percentile, 48% had a length percentile for age below the 10th percentile, and 16% had a head circumference percentile for age below the 10th percentile.

Conclusion: It has been established that provision of breast milk feedings is low in infants with NOWS, estimated to be about 46% during the birth hospitalization in our region. In this descriptive study, the use of human milk after discharge was marginal, highlighting the challenges of breastfeeding in these mother-infant dyads. Moreover, these infants continue to experience growth challenges and receive heterogeneous forms of nutrition. Many public dollars are spent on the specialized formulas as the majority of this sample is insured by Medicaid and utilize WIC. This study highlights the need for further investigation to determine long term nutritional guidance in these at-risk infants. Furthermore, it emphasizes the need for continuing breastfeeding support for mothers with opioid-use disorder.