PC1122: Demographics and Disposition of Infants Exposed to Opioids in Utero

Background: Opioid use nationwide is increasing as well as maternal opioid use during pregnancy due to use of illicit substances, misuse of prescription opioids without valid prescriptions, use of substances laced with opioid (ie fentanyl laced marijuana), and/or enrollment in opioid treatment programs. Opioid use in pregnancy can result in withdrawal signs in the neonate called Neonatal Abstinence Syndrome (NAS). Signs of NAS, such as increased irritability, tremors, increased tone, poor feeding, emesis, decreased ability to sleep, and difficulty to be consoled and are evident in the first few days after birth. Frequently, mothers use opioids in conjunction with other medications such as cocaine, alcohol, tobacco, benzodiazepines, barbiturates, and marijuana confounding the clinical picture. Eat, Sleep, Console (ESC) scoring tool is used to assess severity of withdrawal symptoms. In our institution, mothers are encouraged to room-in with their infants for the duration of the neonatal stay (Empower Program) if they are compliant with an opioid treatment program and have sustained prenatal care.

Methods: All infants born to mothers with opioid use during pregnancy who were admitted to Baystate Children’s Hospital from January, 2021 through April, 2022 are included in this study. Maternal and newborn medical records were reviewed for clinical data. Infants were admitted to the NICU if they had clinical issues such as need for respiratory support, hypoglycemia requiring IV infusion, and prematurity. In addition, all infants in DCF custody were admitted to the NICU. Infants with significant and persistent withdrawal symptoms based on the ESC assessment tool were treated with morphine (MS) frequently in the NICU.

Results: There were 118 infants born at > 34 weeks gestation who were exposed in utero to opioids and admitted to Baystate Children’s Hospital (see table). Eighty-two infants (69%) were admitted to the NICU and the remainder stayed with their mothers. Overall, 65% of the mothers received good prenatal care (PNC) and 65% were enrolled in the Empower Program. Cocaine was present in almost 1/4 of the drug screens. Close to 50% of the mothers who were tested for Hepatitis C antibody had positive results. Thirty-five infants received scheduled MS and 17 infants required only intermittent MS (range 1-9 doses) treatment for their withdrawal symptoms.

Conclusion: Hepatitis C is common in this population. Forty-four percent of infants in this study required treatment with MS after delivery. About 1/3 of the infants admitted to the NICU for clinical concerns who did not have signs of withdrawal on admission did not require MS administration despite the lack of continuous maternal support. Mothers who successfully completed rooming-in with their infants had good prenatal care and were enrolled in the Empower Program.