423 - Physiologic dysregulation in opioid-exposed newborns

Poster Number: 423
Publication Number: 423.136

Elisabeth Bloch-Salisbury, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Nicolas Rodriguez, UMass Medical School, Worcester, MA, United States; Lauren McKenna, University of Massachusetts Medical School, Worcester, MA, United States; Tory M. Bruch, University of Pittsburgh School of Medicine, Des Moines, IA, United States; Lidush Goldschmidt, University of Pittsburgh Medical Center, Pittsburgh, PA, United States

Background: Newborns with prenatal opioid exposure (POE) commonly present with multi-system disturbances of the central and autonomic nervous systems. Despite widespread use of pharmacotherapy to treat symptoms of withdrawal and dysregulated behaviors, little is known about the underlying physiology of opioid-exposed newborns. Objective, physiologic measures over prolonged periods that help quantify dysregulation are needed to better assess and optimize individualized treatment to promote healthy development in at-risk infants with POE.

Objective: Continuous cardiac, respiratory, and movement activity were measured throughout interfeed periods to identify and quantify physiologic dysregulation in newborns with POE.

Design/Methods: Seventeen POE infants (>35 wks; 12 male) hospitalized since birth for neonatal abstinence syndrome participated in an 8-10 hr study session. Infants studied were at different time-points of treatment to obtain a general understanding of physiologic changes that may occur throughout the course of hospitalization. Surface sensors recorded cardiac, respiratory, thermoregulatory and movement activity throughout 2-3 consecutive interfeed periods.

Results: At day of study, infants’ age ranged between 4 and 29 days, withdrawal severity ranged between 4 and 12 maximum Finnegan score, and treatment phase ranged between 0 and 28 days on morphine. Throughout the interfeed period, infants’ heart rate was in normal newborn range (mean 137 bpm, SD 7) though infants were tachycardic 16% of the period including 6 infants who were tachycardic more than 20% of the interfeed period (Figure 1). Infants were tachypneic (mean 74 breaths/min, SD 13) for 62% of the period (Figure 2). Infants moved 33% of the period and 17% were durations >30 sec (Figure 3). Axillary temperature was maintained throughout the period (mean 36.9 ͦ C, SD 0.33). Heart rate was associated with Finnegan score (P=0.02), whereas respiratory rate was related to study day of life and days on pharmacotherapy (P < 0.05).Conclusion(s): Findings support that physiologic signals measured continuously throughout interfeed periods can identify and quantify dysregulation in infants with POE not captured by conventional withdrawal scoring tools that rely on acute observational measures. Measures that distinguish between typical and atypical/dysregulated function are critically important for determining course of treatment to promote healthy developmental outcomes.

Support: NIDA R01DA042074 (Bloch-Salisbury); NIDA R21DA035355 (Bloch-Salisbury); Harvard University Wyss Institute for Biologically Inspired Engineering; Neonatology Associates of Worcester
Heart rate throughout the interfeed period for each infant.
<img src=https://www.abstractscorecard.com/uploads/Tasks/upload/16020/FGOVBGGC-1178865-1-IMG.jpg width=440 hheight=247.5 border=0 style=border-style: none;>Left panel=Mean heart rate (bars=SD); Right panel=Percent time infants were tachycardic (>150-300 bpm).

Respiratory rate throughout the interfeed period for each infant.
<img src=https://www.abstractscorecard.com/uploads/Tasks/upload/16020/FGOVBGGC-1178865-2-IMG.jpg width=440 hheight=247.5 border=0 style=border-style: none;>Left panel=Mean respiratory rate (bars=SD); Right panel=Percent time infants were tachypneic (>60 breaths/min).