Let’s Talk Research!
On this page you will be able to review plain-language summaries of research articles related to prenatal opioid exposure. Articles have been selected and summarized through work of our Next Step Collaborative Research Committee.
Education & Learning
“Educational disabilities among children born with neonatal abstinence syndrome”
In a cohort study published in 2018 by the American Academy of Pediatrics, the Tennessee Department of Health looked at Neonatal Abstinence Syndrome and special education outcomes in early school years. The study included 7,256 children, 1,815 with history of NAS and 5,441 children without prenatal exposure ages 3-8 years old.
This study's key findings for children with prenatal opioid exposure:
More likely to be referred for disability evaluations in school (19.3% compared to 13.7%)
More likely to meet criteria for a disability (15.6% compared to 11.6%).
More likely to require more therapies and services in the classroom (15.3% compared to ll.4%).
Why this matters: Families and professionals supporting children with prenatal opioid exposure should advocate for special education assessment if concerns exist regarding academic performance.
Citation: Fill, M. M. A., Miller, A. M., Wilkinson, R. H., Warren, M. D., Dunn, J. R., Schaffner, W., & Jones, T. F. (2018). Educational disabilities among children born with neonatal abstinence syndrome. Pediatrics, 142(3)
What is a cohort study? - What Is a Cohort Study? | Definition & Examples (scribbr.com)
“Neonatal Abstinence Syndrome and High School Performance”
In a cohort study published in 2017 by the American Academy of Pediatrics, long term educational performance of children born in New South Wales(NSW), Australia were explored. From July 2000-Dec 2006 researchers looked at information from all children within NSW due to availability of linked medical and school records in this region. This study compared 2,234 children with Neonatal Abstinence Syndrome, 4,330 matched controls, and the 598,265 children from the NSW population providing a large group to compare school performance. This study looked at academic performance on The National Assessment Program: Literacy and Numeracy (NAPLAN) in grades 3, 5, and 7.
This study's key findings for children with prenatal opioid exposure:
Educational performance progress worsened as children with NAS aged so that by grade 7, children with NAS scored lower than other children in grade 5
Reduced educational performance progresses as children with NAS aged and progressed throughout their schooling.
Risk of not meeting minimal educational standards was independently associated with NAS and indigenous status, male gender, and lower parental education.
Why this matters: families and professionals supporting children and youth with prenatal opioid exposure should observe for academic concerns throughout their academic career. Monitoring throughout high school and pursuing evaluation through school if seeing academic challenges is indicated.
Citation: Oei, J. L., Melhuish, E., Uebel, H., Azzam, N., Breen, C., Burns, L., … Wright, I. M. (2017). Neonatal Abstinence Syndrome and High School Performance. Pediatrics, 139(2), e20162651. https://doi.org/10.1542/peds.2016-2651
What is a cohort study? - What Is a Cohort Study? | Definition & Examples (scribbr.com)
What are matched controls? - Control Groups and Treatment Groups | Uses & Examples (scribbr.com)
“Prenatal Opioid Exposure and ADHD Childhood Symptoms: A Meta-Analysis”
In a meta-analysis published in 2021 researchers looked at ADHD symptoms in children ages 2-18 years old with a history of prenatal opioid exposure. This study compiled results from 7 published studies, comparing ADHD symptoms of 319 children with prenatal opioid exposure, and 1,308 children non-exposed children. This study looked at ADHD symptoms, specifically hyperactivity and impulsivity, inattention, and combined ADHD symptoms (inattention and hyperactivity). .
This study's key findings for children with prenatal opioid exposure:
Increased ADHD symptoms compared to non-exposed peers - hyperactivity and impulsivity, inattention, and combined ADHD presentation.
ADHD symptoms in children with prenatal opioid exposure may increase with age.
Why this matters: Families of children with prenatal opioid exposure can observe for signs of hyperactivity, impulsivity, and inattention in their children. If concerns occur, they can seek support from their child’s pediatrician or a developmental psychologist for further evaluation and support. Professionals working with children with prenatal exposures should screen for attention and impulsivity concerns in early childhood.
Citation: Schwartz, A. N., Reyes, L. M., Meschke, L. L., & Kintziger, K. W. (2021). Prenatal Opioid Exposure and ADHD Childhood Symptoms: A Meta-Analysis. Children, 8(2), 106. https://doi.org/10.3390/children8020106
What is a meta-analysis? - Meta-analysis: What, Why, and How
Infant Support & Treatment
“Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal”
In a randomized control trial published in 2023 by the New England Journal of Medicine, the use of the Eat Sleep Console (ESC) method for assessing neonatal opioid withdrawal was compared to the Finnegan Neonatal Abstinence Scoring Tool (FNAST). These tools provide a way for healthcare workers to observe severity of neonatal withdrawal symptoms and can guide initiation of pharmacologic intervention. The primary outcome of interest for this study was differences in the time until infants were medically ready to discharge from the hospital. For this study, 26 hospitals across the country participated in two phases with 1,305 infants born between September 2020 and March 2022. The first phase infants were assessed using the FNAST, and second phase infants were assessed using ESC. Of the infants enrolled, 702 received FNAST assessment, and 603 with ESC.
This study's key findings for newborn prenatal opioid exposure assessment:
Average length of time from birth to medical readiness for discharge was shorter in the Eat Sleep Console group (8.2 vs 14.9 days)
Average length of hospital stay was shorter in the Eat Sleep control group (7.8 vs 14 days)
The proportion of infants who received opioid treatment was decreased in the Eat Sleep Control group compared to the NFAST (19.5% vs 52%)
Why this matters: Professionals providing care for infants in the newborn phase should be aware of the benefits of the Eat Sleep Console method and how it can positively improve infant outcomes.
Citation: Young, L. W., Ounpraseuth, S. T., Merhar, S. L., Hu, Z., Simon, A. E., Bremer, A. A., Lee, J. Y., Das, A., Crawford, M. M., Greenberg, R. G., Smith, P. B., Poindexter, B. B., Higgins, R. D., Walsh, M. C., Rice, W., Paul, D. A., Maxwell, J. R., Telang, S., Fung, C. M., … Devlin, L. A. (2023). Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal. In New England Journal of Medicine (Vol. 388, Issue 25, pp. 2326–2337). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2214470
What is a randomized control trial - Randomized Controlled Trial (RCTs)- Definition, Features, Principle, Steps (microbenotes.com)
“Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder”
The Academy of Breastfeeding Medicine has released updated information on breastfeeding safety for patients experiencing substance use disorder. In this protocol, they give recommendations on the potential risks and benefits of substance exposure through breast milk. Information provided in this protocol are supported by research.
This study's key findings for children with prenatal opioid exposure:
Breastfeeding recommendations are provided for a variety of situations: non-prescribed opioids, substance use disorder medication treatment, stimulants, sedative-hypnotics, alcohol, nicotine, and cannabis use.
Individualized care plans should be created between the patient and a multidisciplinary team to support breastfeeding.
Breastfeeding is recommended in patients that stop nonprescribed substance use by the time of delivery, they should make sure to continue appropriate postpartum care.
Why this matters: Caregivers and medical professionals should be aware of the potential benefits and risks of breastfeeding for individuals with substance use disorder. Safe breastfeeding is possible under specific circumstances. Medical professionals should use this protocol to support their patients in identifying when it is safe to breastfeed their child.
Citation: Harris, M., Schiff, D. M., Saia, K., Muftu, S., Standish, K. R., & Wachman, E. M. (2023). Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeeding Medicine, 18(10), 715–733). https://doi.org/10.1089/bfm.2023.29256.abm
“Rooming-in for Infants at Risk for Neonatal Abstinence Syndrome”
In a study published by the American Journal of Perinatology, researchers explored the impact of “rooming-in” for newborns with NAS. Rooming-in is an approach to care where a newborn baby stays with their mother/parent after birth, which allows the parent to practice caring and responding to their child’s needs. This study compares opioid exposed babies, 24 that were admitted to the NICU after birth, and 20 babies that roomed-in after birth. In this study they compared the number of babies that required medication treatment for withdrawal, and the length of hospital stay.
This study's key findings for children with prenatal opioid exposure:
· Infants that were able to room-in were significantly less likely to require initiation of pharmacologic intervention and have a prolonged hospital stay.
· A portion of infants that could have benefited from rooming in required admission to the NICU for reasons others than NAS.
Why this matters: Rooming in has shown benefits in supporting infants in their early care management and has decreased hospital stay duration and need for pharmacologic treatment. Rooming-in is also beneficial in supporting a caregiver’s opportunity to be a part of their child’s care.
Citation: Newman, A. I., Mauer-Vakil, D., Coo, H., Newton, L., Wilkerson, E., McKnight, S., & Brogly, S. B. (2020). Rooming-in for Infants at Risk for Neonatal Abstinence Syndrome: Outcomes 5 Years following Its Introduction as the Standard of Care at One Hospital. American Journal of Perinatology, 39(8), 897–903). https://doi.org/10.1055/s-0040-1719182