421 - Do Small For Gestational Age Infants Experience Less Severe Neonatal Abstinence Syndrome?

Poster Number: 421
Publication Number: 421.136

Daniela Friedman, Sidney Kimmel Medical College at Thomas Jefferson University, Dunwoody, GA, United States; Nida Zubair, Thomas Jefferson University, Philadelphia, PA, United States; Zubair Aghai, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States

Background: Small for gestational age (SGA) infants are likely to have lower amounts of fat deposition of opioids and other substances, hence less severe neonatal abstinence syndrome (NAS). Literature is sparse to demonstrate the existence of a relationship between weight restriction at birth and the severity of NAS.

Objective: The goal of this study is to correlate SGA status and severity of NAS in infants admitted to the neonatal intensive care unit (NICU).

Design/Methods: This is a retrospective analysis of term and late-preterm infants (≥35 weeks gestation) exposed to in utero substances, born between September 2006 and May 2021, and admitted to an inner-city NICU for medical therapy for NAS. Indicators of the severity of NAS (duration of medical treatment, duration of hospitalization, use of phenobarbital, and use of clonidine) were compared between infants characterized as SGA (birth weight < 10th percentile for gestational age) to those not categorized as SGA (non-SGA). Infants who did not require medical therapy or transferred to another facility were excluded. The groups were compared using the Student t-test, Mann-Whitney U test, Chi-square, and Fisher exact test as appropriate.

Results: A total of 992 infants met the study criteria; 205 (20.7%) in the SGA group and 787 (79.3%) in the No SGA group. There was no significant difference in baseline characteristics including use of cocaine, marijuana, benzodiazepines, selective serotonin reuptake inhibitors, methadone dose, sex, or race between the groups. There was a higher proportion of exposure to smoking in the SGA group. The median duration of medical treatment was significantly lower in infants in the SGA group (22 days vs. 26 days, p= 0.04). Infants in the SGA group were less likely to be treated with phenobarbital than the No SGA group (19% vs. 26.8%, p= 0.02). There was a trend toward a shorter duration of hospitalization for infants in the SGA group (27 days vs. 32 days, p= 0.07) and less frequent treatment with clonidine for infants in the SGA group (0.97% vs. 3.4%, p=0.06).Conclusion(s): Infants characterized as SGA displayed less severe NAS as indicated by shorter duration of medical treatment and decreased treatment with phenobarbital. Additionally, trends demonstrated shorter durations of hospitalization and clonidine treatment for SGA infants. Based on these findings, infants characterized as SGA at birth may have less severe symptoms of NAS and may require less escalated medical treatment with phenobarbital and clonidine. Our findings may impact decisions around identifying the optimum treatment protocols catered to SGA infants with NAS.
Daniela Friedman CVFriedman Daniela CV (2).pdf
Table 2: Comparison of outcomes in SGA and no-SGA neonatesData presented as median (IQR) or N (%)