260 - Body Composition of Newborn Infants with Neonatal Opioid Withdrawal Syndrome (NOWS) During Hospitalization

Poster Number: 260
Publication Number: 260.131

Prabhu S. Parimi, Metro Health Medical Center, Cleveland, OH, United States; Stephanie Merlino Barr, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Noor Asi, Metrohealth Medical Center, Cleveland, OH, United States; Deepak Kumar, Case Western Reserve University School of Medicine-MetroHealth Medical Center, Cleveland, OH, United States

Background: Newborns with Neonatal Opioid Withdrawal Syndrome (NOWS) have neurological hyperexcitability and autonomic instability frequently associated with initial weight loss due to poor feeding and loose stools which upon control of NOWS frequently gives way to hyperphagia. Effect of hyperphagia on body composition during the first few weeks of life in infants with NOWS is not described. In this pilot study, we report change in body composition in newborns with NOWS during hospitalization.

Objective: To measure body composition of newborn infants with NOWS during the first week of life and at discharge using Air Displacement Plethysmography.

Design/Methods: Newborn infants >36 weeks' gestation admitted to NICU for the management of NOWS (n=18) were included in this pilot study. Initial management consisted of non-pharmacological measures and own mother's milk (OMM), if available. Modified Finnegan Scores were used to monitor NOWS. Morphine was started for two consecutive scores >8 or a score of 12. The starting dose was .05 mg/kg/dose every 3 hours, titrated to control symptoms, weaned by 10% of the highest dose every 24 hours and discontinued at 0.02 mg/kg/dose. Phenobarbital was used as adjunctive medication. Infants received either OMM/breast feed or term formula with caloric adjustments made as necessary. Air Displacement Plethysmography (ADP) using PeaPod ® system located in the NICU was used to measure body composition within the first week of life and again 24-48h prior to discharge. Relevant clinical and nutritional data was obtained. Descriptive statistics, paired t test and Pearson correlation were used to analyze the data.

Results: Study infants (BW 2807 ±555 g, GA 37±2 weeks, 11 females vs. 7 males) had hyperphagia (198 ±33 ml/kg/d) after 3 weeks of age. The duration of morphine was 24±15 days and Phenobarbital was added in 5 (27%) infants. The first ADP was performed at 8±4 days and prior to discharge at 25 ± 14 days. The initial ADP demonstrated significantly higher fat mass in females compared to males (p.03) and there was a significant increase in fat mass and decrease in Fat Free Mass in both genders (p < .01) during hospitalization (Table). Change in fat mass (R2 .65, p< .01) and Fat Free Mass (R2 .47, p< .01) correlated with duration of pharmacotherapy (Figure).Conclusion(s): Fat mass increased in newborns with NOWS during the first month of life compared to the published data at 1 week and 1 month of age (Fields DA, 2011). This increase is concordant with hyperphagia and duration of pharmacotherapy. Examination of underlying factors and long-term follow-up is necessary.
Clinical and Nutritional Data
Change in Fat Mass and Fat Free Mass During Hospitalization