Sensory Profiles in Infants with Neonatal Opioid Withdrawal Syndrome

Riley C. McNabb, Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, New Albany, OH, United States; Aishwarya Tallikar, Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, United States; Nathalie L. Maitre, Emory University and Children’s Healthcare of Atlanta, United States; Sara Conroy, Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, United States; Mary Lauren Neel, Emory University and Children’s Healthcare of Atlanta, United States; Kristen L. Benninger, Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States

Background: Infants with prenatal opioid exposure (POE) exhibit neurobehavioral dysregulation in the neonatal period. Neurobehavioral differences related to prenatal exposures are associated with developmental and behavioral outcomes. No studies have characterized sensory behavior in this population beyond the neonatal period.

Objectives: Characterize sensory profiles of infants with neonatal opioid withdrawal syndrome (NOWS) at 3-4 and 9-12 months (mo).

Design/Methods: Prospective observational cohort study. Eligibility criteria: POE and pharmacologic treatment for NOWS. We collected clinical information and maternal social risk and demographic characteristics from the medical record and structured caregiver interview. The Infant/Toddler Sensory Profile (ITSP) is a standardized questionnaire based on Dunn’s Model of Sensory Processing and characterizes interactions between a child’s neurological threshold, behavioral response, and self-regulation strategies. Caregivers completed the ITSP at 3-4 and 9-12mo of age. The ITSP yields 4 quadrant scores (low registration, sensation seeking, sensory sensitivity, and sensation avoiding); classified as typical or atypical, corresponding to +/- 1 or more standard deviations (SD) from the mean based on a normative sample. The study was IRB approved; informed consent was obtained from parent or legal guardian.

Results: We enrolled 201 infants from October 2018 to March 2020 (Figure 1). Maternal demographic and pregnancy characteristics are presented in Table 1. All infants had POE; 74.1% had polysubstance exposure. Delivery and infant baseline clinical characteristics are listed in Table 2. One-hundred and seventy-eight (89%) and 161 (80%) subjects completed 3-4mo and 9-12mo visits. One-hundred and forty-four (72%) subjects had an ITSP at each timepoint (Table 3). Among infants with atypical performance on the low registration (9-12mo), sensation seeking (3-4 & 9-12mo), sensory sensitivity (3-4 & 9-12mo) and sensation avoiding (3-4mo) scales, the majority were classified as having these behavior patterns “more than others”. Infants meeting criteria for a low threshold categorization increased from the 3-4 to 9-12mo timepoints (3.5 to 13.2%).

Conclusion: Some infants with POE have atypical sensory processing in the first year of life. Most atypical scores indicated sensory overresponsiveness compared to peers. Future work will investigate associations between ITSP profiles, parenting stress, and developmental and behavioral outcomes.