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Crocker, Abigail

Clinical Neuroscience Research Unit

2013

Ph. D.

Introduction: It is estimated that more than 20,000 children are born to opioid-dependent women in the United States every year. Opioid use during pregnancy is associated with an increased risk of poor neonatal outcomes including neonatal abstinence syndrome (symptoms of opioid withdrawal). Sixty percent of opioid-exposed newborns will develop neonatal abstinence syndrome (NAS) that requires pharmacologic treatment. It is important to correctly identify newborns at increased risk for NAS so that appropriate therapies can be initiated in a timely manner. Exactly which opioid-exposed newborns will experience withdrawal symptoms severe enough to warrant pharmacologic treatment is variable. Many researchers agree that withdrawal severity is related to material opioid treatment type, but the variability is not well understood. More research is needed in identifying which of these newborns are at highest risk of developing NAS.
Opioid-dependent mothers and their newborns are a particularly high-risk, vulnerable population. It is important to identify these women and their infants early in the care process so that supportive measures can be taken to help ensure positive outcomes. This type of support is needed during the prenatal, immediate post partum periods and beyond. One method for supporting these women is to encourage breastfeeding. The benefits of breastfeeding for the mother and the child are well known however breastfeeding rates in this population are reported to be as low as 20% initiation. More information is needed on what barriers exist in this population so that targeted interventions can be performed in order to increase the chances of successful breastfeeding practices.
Methods: In chapter 1, a review of current diagnostic tools used in the evaluation of NAS was conducted. The individual strengths and weaknesses of the two major tools were assessed according to the four categories of diagnostic technology assessment. In chapter 2, clinical data for 777 newborns with a known continued in-utero opioid exposure were analyzed to determine the value of certain clinical measures in predicting NAS. Descriptive statistical techniques were performed to describe the study population, univariate analyses were used to identify variables with potential predictive value (p Results: The two most common NAS scoring systems used in practices today were found to be relatively weak diagnostic tools. While they both demonstrate biologic plausibility and clinical impact, limited data on the validity and reliability exist. Exploring new methods for stratifying opioid-exposed newborns on risk of development of neonatal abstinence syndrome resulted in a multivariate predictive model where maternal treatment type and dose, infant head circumference and APGAR score were found to have significant predictive value. Barriers to successful breastfeeding practices in this population are largely centered on lack of knowledge of current guidelines and safety considerations. Conclusion: Newborns of opioid-dependent mothers are at risk for poor clinical and social outcomes. More research is needed to better understand ways to reduce risk and support positive outcomes.