595 - Associations of Behavioral Problems with Developmental Outcomes in a Prospective Cohort of Children with Neonatal Opioid Withdrawal Syndrome

Publication Number: 595.3731

Kristen L. Benninger, Nationwide Children's Hospital, Columbus, OH, United States; Sara Conroy, Nationwide Children's Hospital, Columbus, OH, United States; Riley C. McNabb, Nationwide Children’s Hospital, New Albany, OH, United States; Gillian S. Gorocica, Nationwide Children's Hospital, Los Angeles, CA, United States; Aishwarya A. Tallikar, University of Illinois College of Medicine, Chicago, IL, United States; H. Gerry Taylor, Nationwide Children’s Hospital, Columbus, OH, United States; Nathalie L. Maitre, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, United States

Background: Children with neonatal opioid withdrawal syndrome (NOWS) are at higher risk for developmental and behavioral problems. Child behaviors including emotional regulation, attention, and executive function are important for optimal performance on developmental assessments and academic success.

Objective: To evaluate the relationship of child behaviors to cognitive, language, and motor development in 2-3 year old children with a history of NOWS.

Design/Methods: Prospective observational cohort of 205 subjects with NOWS. Inclusion criteria: birth gestational age ≥34 weeks with in-utero opioid exposure and pharmacologic treatment for NOWS. We excluded infants with significant congenital or genetic anomalies. Outcomes were assessed between 2 and 3 years of age using the Bayley Scales of Infant and Toddler Development (Bayley, 3rd or 4th edition) and Child Behavior Checklist 1 ½-5 years (CBCL). The CBCL is a parent rating of symptoms of behavioral and emotional problems in young children. Symptom ratings are age normed using T-scores and corresponding percentiles, with higher scores or percentiles reflecting more problem behaviors. Scores between the 93-97th percentile are in the ‘borderline’ clinical range and scores above the 97th percentile are in the ‘clinical’ range. Linear regression models estimated the difference in Bayley scores by CBCL classification. The study was IRB approved; informed consent was obtained from the legal guardian.

Results: We enrolled 205 infants from October 2018 to March 2020. Pregnant person and infant characteristics are presented in Table 1. All infants in the cohort had in utero exposure to opioids and polysubstance exposure was common (74%). One-hundred sixty-seven infants (81%) completed at least a partial 2- to 3-year developmental visit. Infants with NOWS had lower Bayley scores compared to published norms in the cognitive, language, and motor domains. ‘Borderline’ or ‘clinical’ level symptoms on the internalizing, withdrawn, and autism spectrum problems scales of the CBCL correlated significantly with lower scores in all categories on all Bayley scales in both unadjusted and adjusted analyses. Borderline or clinical level symptoms on the total problems, emotionally reactive, and attention problems scales of the CBCL correlated significantly with lower Bayley cognitive scores.

Conclusion(s): Parent-reported behavior problems were related to lower cognitive, language, and motor development in children with a history of NOWS. Early identification and intervention to address both behavioral and developmental problems could improve school success in this high-risk population.

Table 1. Pregnant person and infant baseline characteristics


Table 2. Developmental and behavioral outcomes at 2-3 years in children with NOWS


Table 3. Associations of behavioral problems with developmental outcomes in children with NOWS