416 - Assessing Neonatal Opioid Withdrawal Syndrome Severity as a Function of Umbilical Cord Tissue Concentrations

Poster Number: 416
Publication Number: 416.136

Divya Rana, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Allison McLeod, Regional One Health, Memphis, TN, United States; Piyamas Gaston, Regional One Health, Memphis, TN, United States; Massroor Pourcyrous, UTHSC, Memphis TN, Memphis, TN, United States

Background: Previous studies demonstrated that infants born to mothers with opioid dependence disorder treated with buprenorphine had a significantly shorter neonatal opioid withdrawal syndrome (NOWS) treatment duration, lower morphine doses, and shorter hospital stays than infants exposed to methadone. However, clinicians continue to lack methodology to predict NOWS severity through quantified buprenorphine exposure and biologic testing results.

Objective: The purpose of this study was to assess the relationship between buprenorphine exposure, umbilical cord tissue (UCT) concentrations, risk of NOWS development and severity.

Design/Methods: A single-center, prospective cohort study was conducted of neonates exposed to buprenorphine in utero. Comparisons between quantified buprenorphine exposure, neonatal UCT concentrations, NOWS diagnosis, and severity were made using an intention to treat regression analysis.

Results: A total of 24 mothers and 25 neonates were included. A positive relationship was seen between active metabolite concentrations and symptomatic scoring (and treatment?). Buprenorphine + norbuprenorphine UCT (Beta coefficient 0.36, 95% CI 0.002 to 0.72, p = 0.049) equated in a 1 point increase in modified Peak Finnegan. All other comparisons yielded non-significant results.Conclusion(s): UCT testing allows for more precise quantification of in utero substance exposure. Yet, buprenorphine and norbuprenorphine UCT concentrations may be associated with severe NOWS development and were associated with longer duration of exposure and higher peak Finnegan scoring.
Table I. Maternal Baseline Characteristics (n =24)