Abstract
Objective
This study aimed to evaluate the impact of in-utero illicit fentanyl exposure on neonatal
outcomes, including neonatal opioid withdrawal syndrome (NOWS), length of stay (LOS),
and treatment requirements.
Study Design
This study was conducted from March 2020 to December 2022, and focused on neonates
born to mothers with opioid use or opioid use disorder (OUD). Maternal opioid use
was identified through self-report or umbilical cord tissue (UCT) testing. Severe
NOWS was defined as cases requiring pharmacological treatment. Statistical analyses
included univariate comparisons, logistic regression, and generalized linear models
to assess the associations between fentanyl exposure and neonatal outcomes.
Results
Forty-seven percent (75/159) of infants had in-utero fentanyl exposure. Fentanyl-positive
mothers were older, 31 ± 5 years, compared to non-fentanyl mothers, 29 ± 5, p = 0.01. They were also less likely to receive prenatal care (p < 0.01) and had a higher number of polysubstance used, 5 ± 1 compared to non-fentanyl
mothers, 3 ± 1, p < 0.01. Overall, infants exposed to fentanyl had a higher incidence of severe NOWS
(odds ratio = 5.8, 95% confidence interval [CI]: 2.49–12.95, p < 0.01) and required earlier NOWS treatment initiation, 1 ± 1 day compared to non-exposed
infants 3 ± 2 days, p < 0.01. In adjusted analysis, fentanyl exposure was associated with a nearly three-fold
increased risk of NOWS (Mantel–Haenszel combined relative risk = 2.98, 95% CI: 1.94–4.57).
Furthermore, fentanyl exposure led to longer LOS, with a 40% increase for preterm
neonates (p < 0.01) and a 63% increase for full-term neonates (p < 0.01). Additionally, there was a significant correlation between log fentanyl concentration
in umbilical cord tissue and cumulative morphine dose required for NOWS treatment,
p = 0.001.
Conclusion
Prenatal illicit fentanyl exposure is an independent and strong risk factor for severe
NOWS presentation in newborns requiring extended hospital stays.
Key Points
-
Illicit fentanyl is increasingly recognized as a major driver of opioid-related substance
use disorders during pregnancy, often occurring alongside polysubstance use.
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Significant prenatal exposure to opioids is a well-established risk factor for neonatal
opioid withdrawal syndrome. The recent rise in illicit fentanyl use has heightened
these concerns.
-
Both preterm and term infants are at risk for severe withdrawal symptoms following
prenatal exposure to illicit fentanyl.
Keywords
prenatal opioid exposure - illicit fentanyl - neonatal opioid withdrawal syndrome
