Associate Professor UTHSC University of Tennessee Health Science Center Memphis, Tennessee, United States
Background: Xylazine is an α2-agonist used in veterinary practices as a sedative and an adjunct to anesthesia. It has numerous side effects in animals, including cardiovascular instability, respiratory suppression, gastrointestinal dysmotility, hyperglycemia and late gestation abortions. Concurrent use of xylazine with opioids by adults suffering from substance use disorder has led to an increase in ER visits, both fatal and non-fatal. This case series explores postnatal complications in four neonates prenatally exposed to xylazine and other substances, highlighting severe neonatal morbidity and adverse outcomes associated with such exposure. Objective: This case series explores postnatal complications in four neonates prenatally exposed to xylazine and other substances, highlighting severe neonatal morbidity and adverse outcomes. Design/Methods: This prospective observational study was conducted at a Level III Neonatal Intensive Care Unit (NICU) at Regional One Health (ROH) hospital in Memphis, Tennessee—a regional tertiary perinatal center. Data were abstracted from an ongoing observational study on maternal substance use. Informed consent was waived with IRB approval. Maternal substance use data were collected based on self-reports , urine and cord toxicological testing. Xylazine testing was added to umbilical cord testing in March 2023. Results: Four newborns were identified through umbilical cord testing as positive for both fentanyl and xylazine: average maternal age: 30 ± 6 years, infants' average gestational age: 35 ± 3 weeks and birthweight: 1043 ± 604 grams. Significant findings include: Three out of four cases had inadequate prenatal care. None of the mothers were enrolled in Medication for Opioid Use Disorder (MOUD). All infants required treatment for Neonatal Opioid Withdrawal Syndrome (NOWS). Polysubstance use was common across all cases, Table 1. Specific complications were observed, one preterm infant succumbed to significant pulmonary hypoplasia-related respiratory complications. Another infant presented significant direct hyperbilirubinemia at birth and was subsequently diagnosed with biliary atresia.
Conclusion(s): Xylazine exposure in utero was associated with significant postnatal morbidity, including respiratory failure, biliary atresia, HIE, and NOWS. The absence of maternal medications for opioid use disorder (MOUD) and the severity of neonatal complications highlight the need for urgent investigation into the effects of xylazine on neonatal outcomes. We also recommend xlyazine testing in neonates with history of prenatal polysubstance use exposure.
Table 1: Xylaxine Use among Pregnant Women with Substance Use Disorder and Neonatal Outcomes
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