263 - Growth failure in Infants Requiring Pharmacologic Treatment for Neonatal Opioid Withdrawal Syndrome

Poster Number: 263
Publication Number: 263.131

Erin Morris, University of Minnesota Masonic Children's Hospital, Roseville, MN, United States; Michael D. Evans, University of Minnesota, Minneapolis, MN, United States; Sarah Pelinka, Hennepin County Medical Center, Minneapolis, MN, United States; Constance Adkisson, Hennepin County Medical Center, Minneapolis, MN, United States; Ashajyothi Mooganayakanakote Siddappa, Hennepin Healthcare/University of Minnesota, Minnneapolis, MN, United States

Background: Infants with Neonatal Opioid Withdrawal Syndrome (NOWS) admitted to neonatal intensive care unit (NICU) present with severe withdrawal symptoms, exhibit disorganized and ineffective sucking leading to poor intake and poor weight gain. Despite the extent of these symptoms in infants with NOWS, their intake and inpatient growth have not been well described.

Objective: To describe growth trajectories, intake and factors contributing to poor growth in infants with NOWS requiring pharmacologic treatment.

Design/Methods: Charts of 119 term infants admitted to the NICU requiring pharmacologic NOWS treatment over seven years were reviewed for diagnosis of Neonatal Abstinence Syndrome and prenatal exposures, growth parameters, calorie intake, volume and type of pharmacologic treatment were collected. Growth parameters were calculated using WHO z-scores. Growth measurement patterns over time were compared between groups (prenatal exposure, treatment) using longitudinal mixed-effects models with natural cubic splines for age, with fixed effect terms for age, group, age-by-group interaction, gestational age at birth, and random effects terms for intercept and age by infant. Intake data was analyzed by exposure and treatment groups using the Tukey method for statistical significance.

Results: There was a trend in decreasing z-score for weight during the hospital stay. The median birth weight by z-score was -0.19 and at discharge,this z-score decreased to a median of -0.72(Table 1).Exposure to short acting opioids was associated with the highest z-scores nearing discharge across all growth parameters. Polysubstance exposure was associated with lowest z-scores for length and OFC throughout hospitalization (Fig 1). Additionally, infants with adjunctive clonidine treatment (with or without phenobarbital) had the most improvement in weight z-score trend. Despite difference in growth trajectories, intake in volume and calorie was not statistically different between treatment groups or exposure groups (Fig 2).Conclusion(s): Infants requiring pharmacologic treatment for NOWS have overall negative z-scores by weight, length, and head circumference at birth and at hospital discharge. Despite similar intake in volume and calories, the growth trajectories were different with prenatal polysubstance exposure infants were at particular risk for poorer inpatient growth and infants treated with adjunctive clonidine were associated with improved inpatient weight trajectories. It is important to know specific risk factors that impact inpatient growth can aid physicians in optimization of feedings for infants with NOWS at risk.
Table 1Demographic Characteristics (Nf 119)
Figure 1Growth trajectories for weight, length and OFC - for-age z-score, by exposure on the top panel and by treatment in the bottom panel, X-axis shows age in days, Y-axis shows z-score.