247 - Assessing Growth in Children With a History of Prenatal Opioid Exposure

Poster Number: 247
Publication Number: 247.224

Maya Khan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Kera M. McNelis, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer McAllister, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: The incidence of Neonatal Opioid Withdrawal Syndrome (NOWS) has increased significantly in the setting of the opioid crisis. Infants with NOWS exhibit symptoms of neurologic and autonomic excitability resulting in increased metabolic demands. These babies are often born smaller for gestational age and initially require higher calories, but little is known about their growth patterns after discharge from the birth hospital. 

Objective: To describe growth patterns and outcomes in children with a history of NOWS.

Design/Methods: We retrospectively analyzed anthropometric, custodian and dietary data of children with a history of prenatal opioid exposure for the first two years of life who were seen in the NOWS Follow-up Clinic at Cincinnati Children’s Hospital Medical Center (CCHMC) from 2015 to 2020. Children born less than 35 weeks gestation, who had underlying complex medical problems, or children who did not live to the age of 2 years were excluded. Data from encounters in the CCHMC electronic medical record were extracted and included in the analysis. We evaluated growth metrics including weight, length and head circumference. Anthropometric z scores were determined per WHO growth standards for sex and age with use of PediTools.org. 

Results: There were 1,395 infants with at least one visit in the NOWS Follow-up Clinic. After excluding 136 patients who did not meet inclusion criteria, there was a final sample size of 1,248 children. This included 7700 encounters that had at least one anthropometric data point documented. Our sample comprised of 51% males and 49% females with a mean gestational age of 38 weeks and mean birth weight of 2969g. There were 63% of children in the custody of biological parents at some time in the first two years of life. The majority (74%) were exposed to long-acting opioids, and the remaining 26% were exposed to short acting opioids and/or polysubstances. In this cohort, 91% of infants were pharmacologically treated for NOWS with an average length of treatment of 10.6 days. Forty-four percent of the z scores for length were below –1.28 (less than the tenth percentile). There was a greater percentage of patient encounters with a length z score under -1.28 than weight z score below -1.28. Conclusion(s): This is the largest study describing long term growth patterns in children with prenatal opioid exposure. We conclude that the distribution of z scores for length by age is not normative, and there is a high rate of stunting during early childhood. Further research is needed to understand the potential associations between risk factors and impaired growth trajectories.  
CV- Maya KhanCV- MK.pdf
Weight z scores by age for children with a history of prenatal opioid exposure.Weight z scores by age for children with a history of prenatal opioid exposure for the first two years of life. This includes 1248 children with 6573 patient encounters