1
|
Coviello C, Lori S, Bertini G, Montano S, Gabbanini S, Bastianelli M, Cossu C, Cavaliere S, Lunardi C, Dani C. Morphine exposure and prematurity affect flash visual evoked potentials in preterm infants. Clin Neurophysiol Pract 2024; 9:85-93. [PMID: 38371463 PMCID: PMC10869246 DOI: 10.1016/j.cnp.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/14/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Objective The present study aimed to explore first the impact of perinatal risk factors on flash-VEP waves and morphology in a group of preterm infants studied at term equivalent age (TEA). Second, to correlate VEP morphology with neurological outcome at 2 years corrected age (CA). Methods Infants with a gestational age (GA) at birth <32 weeks, without major brain injury, were enrolled. Multivariate regression analyses were performed, and the models were run separately for each dependent variable N2, P2, N3 latencies and P2 amplitude. Logistic regression was applied to study N4 component (present/absent) and VEP morphology (regular/irregular). The predictors were GA, bronchopulmonary dysplasia (BPD), postmenstrual age at VEP registration, cumulative morphine and fentanyl dose, and painful procedures. Lastly, linear regression models were performed to assess the relation between the Bayley-III cognitive and motor scores at 2 years CA and VEP morphology, in relation to GA, BPD, painful procedures and cumulative morphine dose. Results Eighty infants were enrolled. Morphine was the predictor of N2 (R2 = 0.09, p = 0.006), P2 (R2 = 0.11, p = 0.002), and N3 (R2 = 0.13, p = 0.003) latencies. Younger GA was associated with lower amplitude (R2 = 0.05, p = 0.029). None of the independent variables predicted the presence of N4 component, nor VEP morphology in the logistic analysis. VEP morphology was not associated with cognitive and motor scores at 2 years. Conclusions Morphine treatment and prematurity were risk factors for altered VEPs parameters at TEA. In our cohort VEP morphology did not predict neurological outcome. Significance Morphine administration should be evaluated according to potential risks and benefits, and dosage individually accustomed, according to pain and comfort scores, considering the possible risk for neurodevelopmental impairment.
Collapse
Affiliation(s)
- Caterina Coviello
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Silvia Lori
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Giovanna Bertini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Simona Montano
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Simonetta Gabbanini
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Maria Bastianelli
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Cesarina Cossu
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Sara Cavaliere
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Clara Lunardi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy
| |
Collapse
|
2
|
Hamilton R, Mulvihill A, Butler L, Chow A, Irving E, McCulloch DL, McNeil A, Michael K, Spowart KM, Waterson-Wilson J, Mactier H. Impaired vision in children prenatally exposed to methadone: an observational cohort study. Eye (Lond) 2024; 38:118-126. [PMID: 37402864 PMCID: PMC10764882 DOI: 10.1038/s41433-023-02644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND/OBJECTIVES To examine prevalence of failed visual assessment at 8-10 years in children born to methadone-maintained opioid dependent (MMOD) mothers and relate this to known in utero substance exposure. SUBJECTS/METHODS Follow up of observational cohort study of methadone-exposed and comparison children matched for birthweight, gestation and postcode of residence at birth. Participants were 144 children (98 exposed, 46 comparison). Prenatal drug exposure was previously established via comprehensive maternal and neonatal toxicology. Children were invited to attend for visual assessment and casenotes were reviewed. Presence of acuity poorer than 0.2 logMAR, strabismus, nystagmus and/or impaired stereovision constituted a 'fail'. Fail rates were compared between methadone-exposed and comparison children after adjusting for known confounding variables. RESULTS 33 children attended in person: data were also derived from casenote review for all children. After controlling for maternal reported tobacco use, methadone-exposed children were more likely to have a visual 'fail' outcome, adjusted odds ratio 2.6, 95% CI 1.1-6.2; adjusted relative risk 1.8 (95% CI 1.1-3.4). Visual 'fail' outcome rates did not differ between methadone-exposed children who had (n = 47) or had not (n = 51) received pharmacological treatment for neonatal abstinence/opioid withdrawal syndrome (NAS/NOWS); fail rate 62% vs 53% (95% CI of difference-11-27%). CONCLUSIONS Children born to MMOD mothers are almost twice as likely as unexposed peers to have significant visual abnormalities at primary school age. Prenatal methadone exposure should be considered in the differential diagnosis of nystagmus. Findings support visual assessment prior to school entry for children with any history of prenatal opioid exposure. TRIAL REGISTRATION The study was prospectively registered on ClinicalTrials.gov (NCT03603301), https://clinicaltrials.gov/ct2/show/NCT03603301 .
Collapse
Affiliation(s)
- R Hamilton
- Royal Hospital for Children, NHS Greater Glasgow & Clyde and the University of Glasgow, Glasgow, G51 4TF, UK.
| | - A Mulvihill
- Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, EH3 9HA, UK
| | - L Butler
- Tennant Institute of Ophthalmology, NHS Greater Glasgow & Clyde, Glasgow, G12 0YN, UK
| | - A Chow
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - E Irving
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - D L McCulloch
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - A McNeil
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, G51 4TF, UK
| | - K Michael
- Crosshouse Hospital, NHS Ayrshire & Arran, Kilmarnock, KA2 0BE, UK
| | - K M Spowart
- Specialist Children's Services, NHS Greater Glasgow & Clyde, Glasgow, G40 1DA, UK
| | - J Waterson-Wilson
- Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, G51 4TF, UK
| | - H Mactier
- NHS Greater Glasgow & Clyde and the University of Glasgow, Glasgow, UK
| |
Collapse
|
3
|
Galli J, Loi E, Franzoni A, Accorsi P, Micheletti S, Pansera L, Fazzi E. Long-Term Visual and Neurodevelopmental Outcomes in Two Children with Congenital Nystagmus Secondary to Methadone Exposure In utero. Neuropediatrics 2023; 54:412-416. [PMID: 37579766 DOI: 10.1055/s-0043-1771388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Methadone is used as a substitute for illicit opioids during pregnancy. However, the real effect of this molecule on visual and neurodevelopmental outcomes of the children exposed is not fully understood, since studies considered subjects born to polydrug-dependent mothers and followed for few months/years. We report the long-term outcomes of two infants with congenital nystagmus solely exposed to methadone in utero. Neurological and neurovisual evaluations were performed every year from the first year of life to 11 years of age. One child was diagnosed with developmental coordination disorder. Both cases presented with ophthalmologic (refractive errors), oculomotor (nystagmus and fixation, smooth pursuit, and saccades dysfunctions), and perceptive problems (reduced visual acuity and contrast sensitivity). While nystagmus and other oculomotor dysfunctions remained stable over time, visual acuity and contrast sensitivity improved; refractive errors worsened and required corrective lenses. Both children showed normal neurodevelopmental and cognitive profile. This report highlights the long-term visual and developmental outcomes of two children exclusively exposed to methadone underlining the possibility of a visual dysfunction and motor coordination disorder. These observations prompt the need to investigate prenatal drug exposure as a cause of congenital nystagmus.
Collapse
Affiliation(s)
- Jessica Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Erika Loi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessandra Franzoni
- Department of Neurological and Vision Sciences, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Patrizia Accorsi
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Laura Pansera
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia, Italy
| |
Collapse
|
4
|
Vella A, Savona-Ventura C, Mahmood T. Harmful effects of opioid use in pregnancy: A scientific review commissioned by the European Board and College of obstetrics and gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2023; 286:70-75. [PMID: 37216740 DOI: 10.1016/j.ejogrb.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Caring for pregnant women who have a recreational opioid use disorder is a common clinical challenge in modern obstetric care. These are an elusive population who often have multiple social issues that complicate their pregnancy management. Comprehensive and supportive maternal care can motivate these mothers to change her lifestyle. Multidisciplinary non-judgemental approach with appropriate medication and management, can result in good pregnancy outcomes for mother and her baby.
Collapse
Affiliation(s)
| | - Charles Savona-Ventura
- Department of Obstetrics and Gynaecology, University of Malta, Member EBCOG Standing Committee on Standards of Care and Position Statements, Malta; Member of the EBCOG Standing Committee on Standards of Care and Position Statements, Malta
| | - Tahir Mahmood
- Victoria Hospital, Kirkcaldy and Spire Murrayfield Hospital, Edinburgh, United Kingdom; Member of the EBCOG Standing Committee on Standards of Care and Position Statements, Malta
| |
Collapse
|
5
|
Naimi BR, Wang RY, Jaleel Z, Levi JR. Otolaryngologic conditions in children with neonatal abstinence syndrome: A descriptive study. Am J Otolaryngol 2023; 44:103885. [PMID: 37043877 DOI: 10.1016/j.amjoto.2023.103885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Literature on otolaryngologic sequelae of children with neonatal abstinence syndrome (NAS) has been scarce to date. Prior reports suggest some otologic conditions associated with long-term NAS outcomes, but no comprehensive exploration of these relationships currently exists. This study aims to characterize the breadth of otolaryngologic conditions diagnosed in children with NAS. METHODS This is a retrospective descriptive study conducted at a tertiary care hospital. We identified 524 children with NAS born between 1/1/2014 and 12/31/2019 who were evaluated by the otolaryngology department. Diagnoses were categorized as otologic, oropharyngeal, sinonasal, and laryngeal. Additional diagnoses of obstructive sleep apnea (OSA) and congenital abnormalities of head and neck were noted separately. Descriptive statistics were calculated, and ANCOVA testing analyzed for differences in mean number of diagnoses. RESULTS 680 total otolaryngologic diagnoses were analyzed across 524 patients. Otologic conditions comprised 39.7 % of total diagnoses, oropharyngeal conditions 26.8 %, sinonasal conditions 18.4 %, laryngeal conditions 5.3 %, OSA 1.5 %, and congenital abnormalities 8.3 %. After adjusting for covariates, there were a significantly higher number of otologic diagnoses compared to the other subcategories with mean (standard deviation) of 0.46 (0.83), followed by oropharyngeal 0.35 (0.55), sinonasal 0.24 (0.49), and laryngeal 0.07 (0.29). Thirty total otolaryngology-related procedures were performed in our sample, with myringotomy with tube insertion as the most common. CONCLUSION Understanding the otolaryngologic sequelae of children with NAS is important as these conditions impact children's early development. Our study also highlights various socioeconomic factors that may impact pediatric ENT care and the follow-up of patients born with NAS.
Collapse
Affiliation(s)
- Bita R Naimi
- Boston University School of Medicine, 72 East Concord St., MA 02118, USA
| | - Rita Y Wang
- Boston University School of Medicine, 72 East Concord St., MA 02118, USA
| | - Zaroug Jaleel
- Boston University School of Medicine, 72 East Concord St., MA 02118, USA; Department of Otolaryngology - Head and Neck Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Jessica R Levi
- Boston University School of Medicine, 72 East Concord St., MA 02118, USA; Department of Otolaryngology - Head and Neck Surgery, Boston University Medical Center, 830 Harrison Avenue, Boston, MA 02118, USA.
| |
Collapse
|
6
|
Benninger KL, McAllister JM, Merhar SL. Neonatal Opioid Withdrawal Syndrome: An Update on Developmental Outcomes. Clin Perinatol 2023; 50:17-29. [PMID: 36868704 DOI: 10.1016/j.clp.2022.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Infants and children with prenatal opioid exposure generally have development within the normal range; however, they seem to be at risk for behavioral problems and for lower scores on cognitive, language, and motor assessments than children without prenatal opioid exposure. It is as of yet unclear whether prenatal opioid exposure itself causes issues with development and behavior, or whether it is simply correlated, due to other confounding factors.
Collapse
Affiliation(s)
- Kristen L Benninger
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Crossroad, WB 5203, Columbus, OH 43215, USA.
| | - Jennifer M McAllister
- Cincinnati Children's Hospital Perinatal Institute, University of Cincinnati College of Medicine, 3333 Burnet Ave, ML 7009, Cincinnati, OH 45229, USA
| | - Stephanie L Merhar
- Cincinnati Children's Hospital Perinatal Institute, University of Cincinnati College of Medicine, 3333 Burnet Ave, ML 7009, Cincinnati, OH 45229, USA
| |
Collapse
|
7
|
Liu J, Grewen K, Gao W. Evidence for the Normalization Effects of Medication for Opioid Use Disorder on Functional Connectivity in Neonates with Prenatal Opioid Exposure. J Neurosci 2022; 42:4555-4566. [PMID: 35552232 PMCID: PMC9172285 DOI: 10.1523/jneurosci.2232-21.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/30/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022] Open
Abstract
Altered functional connectivity has been reported in infants with prenatal exposure to opioids, which significantly interrupts and influences endogenous neurotransmitter/receptor signaling during fetal programming. Better birth outcomes and long-term developmental outcomes are associated with medication for opioid use disorder (MOUD) during pregnancy, but the neural mechanisms underlying these benefits are largely unknown. We aimed to characterize effects of prenatal opioid/other drug exposure (PODE) and the neural basis for the reported beneficial effects of MOUD by examining neonatal brain functional organization. A cohort of 109 human newborns, 42 PODE, 39 with prenatal exposure to drugs excluding opioids (PDE), 28 drug-free controls (males and females) underwent resting-state fMRI at 2 weeks of age. To examine neural effects of MOUD, PODE infants were separated into subgroups based on whether mothers received MOUD (n = 31) or no treatment (n = 11). A novel heatmap analysis was designed to characterize PODE-associated functional connectivity alterations and MOUD-related effects, and permutation testing identified regions of interest with significant effects. PODE neonates showed alterations beyond those associated with PDE, particularly in reward-related frontal-sensory connectivity. MOUD was associated with a significant reduction of PODE-related alterations in key regions of endogenous opioid pathways including limbic and frontal connections. However, significant residual effects in limbic and subcortical circuitry were observed. These findings confirm altered brain functional organization associated with PODE. Importantly, widespread normalization effects associated with MOUD reveal, for the first time, the potential brain basis of the beneficial effects of MOUD on the developing brain and underscore the importance of this treatment intervention for better developmental outcomes.SIGNIFICANCE STATEMENT This is the first study to reveal the potential neural mechanisms underlying the beneficial effects on the neonate brain associated with MOUD during pregnancy. We identified both normalization and residual effects of MOUD on brain functional architecture by directly comparing neonates prenatally exposed to opioids with MOUD and those exposed to opioids but without MOUD. Our findings confirm altered brain functional organization associated with prenatal opioid exposure and demonstrate that although significant residual effects remain in reward circuitry, MOUD confers significant normalization effects on functional connectivity of regions associated with socioemotional development and reward processing. Together, our results highlight the importance of MOUD intervention for better neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Janelle Liu
- Cedars-Sinai Biomedical Imaging Research Institute, Los Angeles, California 90048
- Departments of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, California 90048
| | - Karen Grewen
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
| | - Wei Gao
- Cedars-Sinai Biomedical Imaging Research Institute, Los Angeles, California 90048
- Departments of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, California 90048
| |
Collapse
|
8
|
Ophthalmic outcomes in children exposed to opioid maintenance treatment in utero: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 136:104601. [PMID: 35263646 DOI: 10.1016/j.neubiorev.2022.104601] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/09/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
Opioid use disorder is a significant global issue and the rate of opioid use in women of childbearing age and pregnant women is on the rise. Whilst the adverse general health, cognitive, and neurodevelopmental outcomes of in utero exposure to opioids have been explored, there is a lack of prospective, controlled, longitudinal research into the ophthalmic outcomes. Existing research suggests that there is an association between prenatal exposure and future risk of abnormalities in visual functioning. This systematic review and meta-analysis analysed studies that measured eye abnormalities in infants or children exposed to opioid maintenance therapy in utero and compared them to non-opioid exposed controls. After considering the clinical findings, limitations of the studies, confounding factors, and quantitative analysis, a causal relationship between in utero opioid exposure and future eye abnormalities could not be confirmed. The implications of the findings and their clinical relevance, in addition to identified gaps for future research are also discussed in this paper.
Collapse
|
9
|
Yen E, Davis JM. The immediate and long-term effects of prenatal opioid exposure. Front Pediatr 2022; 10:1039055. [PMID: 36419918 PMCID: PMC9676971 DOI: 10.3389/fped.2022.1039055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
The opioid epidemic has adversely affected neonates and children, yet the mechanisms by which it impacts this population are not well understood. Not only does prenatal opioid exposure result in short-term consequences shortly after birth, it also creates long-term sequelae that may predispose these children to physical, emotional, psychiatric, cognitive, and socioeconomic problems in the future. This article provides a scoping overview of the long-term effects of antenatal opioid exposure on neonates and children as well as quality improvement and research efforts to understand and mitigate this major public health concern.
Collapse
Affiliation(s)
- Elizabeth Yen
- Department of Pediatrics, Tufts Medical Center, Boston, MA, United States.,Mother Infant Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Jonathan M Davis
- Department of Pediatrics, Tufts Medical Center, Boston, MA, United States.,Tufts Clinical and Translational Science Institute, Boston, MA, United States
| |
Collapse
|
10
|
Boardman JP, Mactier H, Devlin LA. Opioids and the developing brain: time to rethink perinatal care for infants of opioid-dependent mothers. Arch Dis Child Fetal Neonatal Ed 2022; 107:98-104. [PMID: 33597225 DOI: 10.1136/archdischild-2020-320102] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/26/2020] [Accepted: 01/14/2021] [Indexed: 11/04/2022]
Abstract
Illicit use of opioids is a global health crisis with major implications for women and children. Strategies for managing opioid use disorder (OUD) in pregnancy have been tested over the past 40 years, but studies have focused on maternal and pregnancy outcomes, with less attention given to long-term follow-up of exposed children. Here, we provide a narrative review of recent advances in the assessment and management of neonatal opioid withdrawal syndrome (NOWS), and we summarise evidence from multiple domains-neuroimaging, electrophysiology, visual development and function, neurodevelopment, behaviour, cognition and education-which suggests that prenatal opioid exposure modifies child development. Further studies are required to determine the optimal management of pregnant women with OUD and babies with NOWS. We identify knowledge gaps and suggest that future study designs should evaluate childhood outcomes, including infant brain development and long-term neurocognitive and visual function.
Collapse
Affiliation(s)
- James P Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK .,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Helen Mactier
- Neonatology, Princess Royal Maternity, Glasgow, UK.,Princess Royal Maternity, University of Glasgow, Glasgow, UK
| | - Lori A Devlin
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
11
|
Shuffrey LC, Rodriguez C, Rodriguez DJ, Mahallati H, Jayaswal M, Barbosa JR, Syme S, Gimenez LA, Pini N, Lucchini M, Fifer WP. Delayed maturation of P2 flash visual evoked potential (VEP) latency in newborns of gestational diabetic mothers. Early Hum Dev 2021; 163:105503. [PMID: 34741833 DOI: 10.1016/j.earlhumdev.2021.105503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 07/22/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) has rapidly increased, yet few prior studies have investigated parameters of early brain development in infants born to gestational diabetic mothers. The present study assessed visual evoked potentials (VEPs) in healthy infants born to gestational diabetic mothers and matched controls. METHODS After exclusions, in this prospective study we examined VEPs in 73 neonates between 37 weeks and 41 weeks gestation at birth (n = 37 infants of gestational diabetic mothers). Stroboscopic flashes were presented through closed eyelids during passive electroencephalography (EEG) recording to derive VEP waveforms during natural sleep. RESULTS There was a statistically significant moderate correlation between gestational age at birth and P2 latency of the flash VEP where P2 latency significantly decreased with increasing gestational age (Pearson's R(73) = -0.32, p < .01). There was also a significant moderate correlation between postnatal age (hours of life) and P2 latency of the flash VEP where P2 latency significantly decreased with increasing postnatal age (Pearson's R(73) = -0.23, p < .05). When controlling for gestational age at birth, postnatal age, and sex, there was a significant effect of group (GDM-exposed vs. control) on P2 latency of the flash VEP (p < .05). Infants of gestational diabetic mothers had a significantly longer P2 latency (M: 215.29 ± SD: 2.58 ms) than controls (M: 206.41 ± SD: 2.62 ms). CONCLUSION Our findings suggest P2 flash VEP latency is a potential measure of cortical maturation and marker of immature development in infants of gestational diabetic mothers.
Collapse
Affiliation(s)
- Lauren C Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America; Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America.
| | - Cynthia Rodriguez
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Daianna J Rodriguez
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Hana Mahallati
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Minna Jayaswal
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Jennifer R Barbosa
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Samantha Syme
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Lissete A Gimenez
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Nicolò Pini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America; Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, United States of America; Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, United States of America; Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States of America
| |
Collapse
|
12
|
Impact of Prenatal Exposure to Opioids, Cocaine, and Cannabis on Eye Disorders in Children. J Addict Med 2021; 14:459-466. [PMID: 31917733 DOI: 10.1097/adm.0000000000000621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Prenatal substance exposure is associated with abnormal visual evoked potentials in offspring, but whether ocular abnormalities are present past infancy is unclear. We determined the association between prenatal substance exposure and hospitalizations for eye disorders in childhood. METHODS We conducted a longitudinal cohort study of 794,099 infants born between 2006 and 2016 in all hospital centers in Quebec, Canada. We identified infants prenatally exposed to opioids, cocaine, cannabis, and other illicit substances and followed them over time to assess eye disorders that required in-hospital treatment, including retinal detachment and breaks, strabismus, and other ocular pathologies. We calculated incidence rates and hazard ratios (HR) with 95% confidence intervals (CI) for the association of prenatal substance exposure with risk of eye disorders, adjusted for patient characteristics. RESULTS Infants exposed to substances prenatally had a higher incidence of hospitalizations for eye disorders compared with unexposed infants (47.0 vs 32.0 per 10,000 person-years). Prenatal substance exposure was associated with 1.23 times the risk of hospital admission for any eye disorder during childhood compared with no exposure (95% CI 1.04-1.45). Risks were greatest for strabismus (HR 1.55, 95% CI 1.16-2.07) and binocular movement disorders (HR 1.96, 95% CI 1.00-3.83). Opioid use was strongly associated with the risk of ocular muscle disorders (HR 3.15, 95% CI 1.98-5.01). CONCLUSIONS Prenatal substance exposure is significantly associated with future hospitalizations for eye disorders in childhood. Efforts to minimize substance use in women of reproductive age are needed in light of the current opioid epidemic.
Collapse
|
13
|
Rees P, Stilwell PA, Bolton C, Akillioglu M, Carter B, Gale C, Sutcliffe A. Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. J Pediatr 2020; 226:149-156.e16. [PMID: 32659230 DOI: 10.1016/j.jpeds.2020.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review and meta-analyze the association between neonatal abstinence syndrome (NAS) and adverse health or educational childhood outcomes. STUDY DESIGN An all-language search was conducted across 11 databases between January 1, 1975, and September 3, 2019; 5865 titles were identified. Observational studies of children between 28 days and 16 years of age, in whom a diagnosis of NAS was documented, were included. Outcomes included reasons for hospital admissions, childhood diagnoses, developmental outcomes, and academic attainment scores. All studies underwent independent review by 2 trained reviewers, who extracted study data and assessed risk of bias using the Newcastle Ottawa Tool. RESULTS Fifteen studies were identified that included 10 907 children with previous NAS and 1 730 213 children without previous NAS, aged 0-16 years. There was a strong association between NAS and subsequent child maltreatment (aOR, 6.49; 95% CI, 4.46-9.45; I2 = 52%), injuries and poisoning (aOR, 1.34; 95% CI, 1.21-1.49; I2 = 0%), and a variety of mental health conditions. Studies consistently demonstrated an increased incidence of strabismus and nystagmus among those with previous NAS. Children with NAS also had lower mean academic scores than the control group in every domain of testing across age groups. CONCLUSIONS NAS is significantly associated with future child maltreatment, mental health diagnoses, visual problems, and poor school performance. Owing to the necessary inclusion of nonrandomized studies, incomplete reporting among studies, and likely unadjusted confounding, this review does not suggest causation. However, we highlight associations requiring further investigation and targeted intervention, to positively impact the life course trajectories of this growing population of children.
Collapse
Affiliation(s)
- Philippa Rees
- Population Policy Practice, NIHR BRC UCL Institute of Child Health, University College London, UK.
| | | | - Chrissy Bolton
- Whittington Health National Health Service Trust, London, UK
| | | | - Ben Carter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, UK
| | - Alastair Sutcliffe
- Population Policy Practice, NIHR BRC UCL Institute of Child Health, University College London, UK
| |
Collapse
|
14
|
Abstract
Prenatal opioid exposure adversely impacts upon fetal growth and places the newborn at risk of neonatal opioid withdrawal. The severity and duration of opioid withdrawal cannot be predicted in the individual baby and may be contributed to by other drugs including benzodiazepines and alcohol as well as cigarette smoking. Mitigating factors include breastfeeding, rooming in and absence of maternal polypharmacy. Less well recognised are a variety of other complications associated with prenatal opioid exposure including epigenetic changes, effects on neurophysiological function and structural alterations to the developing brain. The visual system is significantly affected, with changes to both clinical and electrophysiological function persisting at least to mid-childhood. Longer term neurodevelopmental and behavioural outcomes are confounded by multiple factors including poverty, parent-child interaction and small study numbers, but systematic reviews consistently demonstrate poorer outcomes for those children and young people prenatally exposed to opioids. Crucially, manifestation of neonatal withdrawal is not a prerequisite for important long term problems including behavioural, emotional or motor function disorder, sensory or speech disorder, strabismus and nystagmus. A body of evidence supports an independent adverse effect of prenatal opioid exposure upon fetal brain development, mediated via a systemic neuro-inflammatory process. Children prenatally exposed to opioids should remain under appropriate follow up, at least until school entry, as difficulties may only become apparent in mid-childhood. Future studies of the management of opioid use disorder in pregnancy, including maintenance methadone, must include longer term outcomes for the baby.
Collapse
Affiliation(s)
- Helen Mactier
- Princess Royal Maternity, Glasgow, UK; College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Ruth Hamilton
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; Department of Clinical Physics and Bio-engineering, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK
| |
Collapse
|
15
|
Rausgaard NLK, Ibsen IO, Jørgensen JS, Lamont RF, Ravn P. Management and monitoring of opioid use in pregnancy. Acta Obstet Gynecol Scand 2019; 99:7-15. [DOI: 10.1111/aogs.13677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/03/2019] [Accepted: 06/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Inge Olga Ibsen
- Department of Gynecology and Obstetrics University of Southern Denmark Odense University Hospital Odense Denmark
| | - Jan Stener Jørgensen
- Department of Gynecology and Obstetrics University of Southern Denmark Odense University Hospital Odense Denmark
| | - Ronald Francis Lamont
- Department of Gynecology and Obstetrics University of Southern Denmark Odense University Hospital Odense Denmark
| | - Pernille Ravn
- Department of Gynecology and Obstetrics University of Southern Denmark Odense University Hospital Odense Denmark
| |
Collapse
|
16
|
Monnelly VJ, Hamilton R, Chappell FM, Mactier H, Boardman JP. Childhood neurodevelopment after prescription of maintenance methadone for opioid dependency in pregnancy: a systematic review and meta-analysis. Dev Med Child Neurol 2019; 61:750-760. [PMID: 30511742 PMCID: PMC6617808 DOI: 10.1111/dmcn.14117] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 01/10/2023]
Abstract
AIM To systematically review and meta-analyse studies of neurodevelopmental outcome of children born to mothers prescribed methadone in pregnancy. METHOD MEDLINE, Embase, and PsycINFO were searched for studies published from 1975 to 2017 reporting neurodevelopmental outcomes in children with prenatal methadone exposure. RESULTS Forty-one studies were identified (2283 participants). Eight studies were amenable to meta-analysis: at 2 years the Mental Development Index weighted mean difference of children with prenatal methadone exposure compared with unexposed infants was -4.3 (95% confidence interval [CI] -7.24 to -1.63), and the Psychomotor Development Index weighted mean difference was -5.42 (95% CI -10.55 to -0.28). Seven studies reported behavioural scores and six found scores to be lower among methadone-exposed children. Twelve studies reported visual outcomes: nystagmus and strabismus were common; five studies reported visual evoked potentials of which four described abnormalities. Factors that limited the quality of some studies, and introduced risk of bias, included absence of blinding, small sample size, high attrition, uncertainty about polydrug exposure, and lack of comparison group validity. INTERPRETATION Children born to mothers prescribed methadone in pregnancy are at risk of neurodevelopmental problems but risk of bias limits inference about harm. Research into management of opioid use disorder in pregnancy should include evaluation of childhood neurodevelopmental outcome. WHAT THIS PAPER ADDS Children born to opioid-dependent mothers prescribed methadone are at risk of neurodevelopmental impairment. Exposed infants have lower Mental Development Index and Psychomotor Development Index scores than unexposed children. Atypical visual evoked potentials, strabismus, and nystagmus have increased prevalence. Estimates of impairment may be biased by intermediate to poor quality evidence.
Collapse
Affiliation(s)
| | - Ruth Hamilton
- Department of Clinical Physics and BioengineeringRoyal Hospital for ChildrenGlasgowUK
| | | | | | - James P Boardman
- MRC Centre for Reproductive HealthUniversity of EdinburghEdinburghUK,Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| |
Collapse
|
17
|
Konijnenberg C, Jondalen NM, Husby MF, Melinder A. ERP correlates of cognitive control in children prenatally exposed to methadone or buprenorphine. Dev Neuropsychol 2018; 43:642-655. [PMID: 29979890 DOI: 10.1080/87565641.2018.1493592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Much is still unknown about the potential long-term effects of prenatal methadone and buprenorphine exposure. We examined neural correlates of cognitive control in 19 prenatally methadone and buprenorphine exposed and 21 nondrug exposed children, aged 9-11 years. Children performed a modified version of the Eriksen Flanker task, which taps into selective attention, conflict response, and response inhibition mechanisms. We investigated behavioral responses and the ERP components N1, P2, N2, P3, and the late positive component (LPC). Children in the exposed group showed normal cognitive control function. However, an atypical ERP response related to perceptual and attention allocation processes was found in the exposed group.
Collapse
Affiliation(s)
- Carolien Konijnenberg
- a Department of Psychology , Inland Norway University of Applied Sciences , Lillehammer , Norway.,b Cognitive Developmental Research Unit, Department of Psychology , University of Oslo , Oslo , Norway
| | - Nils Martin Jondalen
- b Cognitive Developmental Research Unit, Department of Psychology , University of Oslo , Oslo , Norway
| | - Mikael Falkhaugen Husby
- b Cognitive Developmental Research Unit, Department of Psychology , University of Oslo , Oslo , Norway
| | - Annika Melinder
- b Cognitive Developmental Research Unit, Department of Psychology , University of Oslo , Oslo , Norway.,c Oslo University Hospital, Child and Adolescent Mental Health , Oslo , Norway
| |
Collapse
|
18
|
Cubero-Rego L, Corsi-Cabrera M, Ricardo-Garcell J, Cruz-Martínez R, Harmony T. Visual evoked potentials are similar in polysomnographically defined quiet and active sleep in healthy newborns. Int J Dev Neurosci 2018; 68:26-34. [PMID: 29698661 DOI: 10.1016/j.ijdevneu.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/21/2018] [Accepted: 04/21/2018] [Indexed: 02/05/2023] Open
Abstract
Morphology and late components of evoked potentials change depending on wake-sleep stages in adults. Visual Evoked potentials (VEPs) have been frequently studied in newborns to identify abnormal development of visual pathways; however, large variability has been reported and there is uncertainty as to the effect of sleep stages on VEPs in neonates. OBJECTIVE To describe the characteristics of VEPs in one month old, healthy full-term newborns during active sleep (AS) and quiet sleep (QS), defined by simultaneous polysomnography (PSG). METHODS VEPs were obtained by monocular LEDs stimulation of each eye during AS and QS, in 20 healthy full-term newborns (gestational age 37-40 weeks) with normal birth weights and normal prenatal Doppler ultrasound indices. Latencies and amplitudes of N2, P2 and N3 components in AS and QS were compared, and their association with absolute power of EEG frequency bands, assessed. RESULTS There were no significant differences in VEP morphology, latencies and amplitudes between sleep states. Typical wave forms were obtained in all newborns in AS; however, no VEPs could be identified clearly in 3 newborns in QS; QS VEPs were less reliable than in AS: more averaging was required; correlation was significantly lower between the VEP averages; and a larger number of babies needed more than two averages to obtain replicable responses needed for clinical purposes. CONCLUSIONS These results indicate that changes in amplitude and latency of some VEP components observed in NREM and REM sleep in adults are not yet present in one month old newborns probably due to immaturity of cortical and sleep mechanisms. VEPs are more reliable during AS than QS in newborns. Systematic VEP recording during AS, and polysomnographic control to identify this stage, are highly recommended as methods that can increase there liability of neonatal VEPs.
Collapse
Affiliation(s)
- Lourdes Cubero-Rego
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico.
| | - María Corsi-Cabrera
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico; Sleep Laboratory, Faculty of Psychology, National Autonomous University of Mexico, 04510, Mexico City, Mexico.
| | - Josefina Ricardo-Garcell
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico.
| | - Rogelio Cruz-Martínez
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico; Department of Fetal Medicine and Surgery, Children's and Women's Specialty Hospital of Querétaro, 76090, Mexico.
| | - Thalía Harmony
- Research Unit in Neurodevelopment, Institute of Neurobiology, National Autonomous University of Mexico, Querétaro, 76230, Mexico.
| |
Collapse
|
19
|
Prenatal methadone exposure is associated with altered neonatal brain development. NEUROIMAGE-CLINICAL 2017; 18:9-14. [PMID: 29326869 PMCID: PMC5760461 DOI: 10.1016/j.nicl.2017.12.033] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
Abstract
Methadone is used for medication-assisted treatment of heroin addiction during pregnancy. The neurodevelopmental outcome of children with prenatal methadone exposure can be sub-optimal. We tested the hypothesis that brain development is altered among newborn infants whose mothers were prescribed methadone. 20 methadone-exposed neonates born after 37 weeks' postmenstrual age (PMA) and 20 non-exposed controls underwent diffusion MRI at mean PMA of 39+ 2 and 41+ 1 weeks, respectively. An age-optimized Tract-based Spatial Statistics (TBSS) pipeline was used to perform voxel-wise statistical comparison of fractional anisotropy (FA) data between exposed and non-exposed neonates. Methadone-exposed neonates had decreased FA within the centrum semiovale, inferior longitudinal fasciculi (ILF) and the internal and external capsules after adjustment for GA at MRI (p < 0.05, TFCE corrected). Median FA across the white matter skeleton was 12% lower among methadone-exposed infants. Mean head circumference (HC) z-scores were lower in the methadone-exposed group (− 0.52 (0.99) vs 1.15 (0.84), p < 0.001); after adjustment for HC z-scores, differences in FA remained in the anterior and posterior limbs of the internal capsule and the ILF. Polydrug use among cases was common. Prenatal methadone exposure is associated with microstructural alteration in major white matter tracts, which is present at birth and is independent of head growth. Although the findings cannot be attributed to methadone per se, the data indicate that further research to determine optimal management of opioid use disorder during pregnancy is required. Future studies should evaluate childhood outcomes including infant brain development and long-term neurocognitive function. Prenatal methadone exposure is associated with atypical white matter development. Reduced FA in the white matter skeleton is apparent soon after birth. Polydrug use among cases limits causal inference. Infant brain development should be evaluated in studies of opioid use in pregnancy.
Collapse
|
20
|
McLaughlin P, Mactier H, Gillis C, Hickish T, Parker A, Liang WJ, Osselton MD. Increased DNA Methylation of ABCB1, CYP2D6, and OPRM1 Genes in Newborn Infants of Methadone-Maintained Opioid-Dependent Mothers. J Pediatr 2017; 190:180-184.e1. [PMID: 28867064 DOI: 10.1016/j.jpeds.2017.07.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/05/2017] [Accepted: 07/13/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate whether in utero opioid exposure, which has been linked to adverse neurodevelopmental and social outcomes, is associated with altered DNA methylation of opioid-related genes at birth. STUDY DESIGN Observational cohort study of 21 healthy methadone-maintained opioid-dependent mother-infant dyads consecutively delivered at >36 weeks of gestation, and 2 comparator groups: smoking, "deprived" opioid-naïve mother-infant dyads (n = 17) and nonsmoking, "affluent" opioid-naïve mother-infant dyads (n = 15). DNA methylation of ABCB1, CYP2D6, and OPRM1 genes for mothers and babies was determined from buccal swabs. Plasma methadone concentrations were additionally measured for methadone-maintained opioid-dependent mothers. RESULTS DNA methylation for ABCB1 and CYP2D6 was similar in opioid-naïve infants compared with their mothers, but was less for OPRM1 (3 ± 1.6% vs 8 ± 1%, P < .0005). Opioid-exposed newborns had similar DNA methylation to their mothers for all genes studied and greater methylation of ABCB1 (18 ± 4.8% vs 3 ± 0.5%), CYP2D6 (92 ± 1.2% vs 89 ± 2.4%), and OPRM1 (8 ± 0.3% vs 3 ± 1.6%) compared with opioid-naïve newborns (P < .0005 for all 3 genes). Infant DNA methylation was not related to birth weight, length of hospital stay, maternal smoking, dose or plasma concentration of methadone at delivery, or postcode of residence. CONCLUSIONS In utero exposure to opioids is associated with increased methylation of opioid-related genes in the newborn infant. It is not clear whether these findings are due to opioid exposure per se or other associated lifestyle factors.
Collapse
Affiliation(s)
- Poppy McLaughlin
- Department of Archaeology, Anthropology, and Forensic Science, Bournemouth University, Poole, United Kingdom
| | - Helen Mactier
- Neonatal Unit, Princess Royal Maternity, Glasgow, United Kingdom.
| | - Cheryl Gillis
- Neonatal Unit, Princess Royal Maternity, Glasgow, United Kingdom
| | - Tamas Hickish
- Department of Molecular Pathology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Anton Parker
- Department of Molecular Pathology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Wei-Jun Liang
- Department of Archaeology, Anthropology, and Forensic Science, Bournemouth University, Poole, United Kingdom
| | - M David Osselton
- Department of Archaeology, Anthropology, and Forensic Science, Bournemouth University, Poole, United Kingdom
| |
Collapse
|
21
|
Yoo SH, Jansson LM, Park HJ. Sensorimotor outcomes in children with prenatal exposure to methadone. J AAPOS 2017; 21:316-321. [PMID: 28709965 DOI: 10.1016/j.jaapos.2017.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/16/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the presentation and characteristics of strabismus in children with prenatal methadone exposure. METHODS The medical records of children with prenatal methadone exposure were retrospectively reviewed. Those who were evaluated by pediatric ophthalmology were included. Information on the timing and types of prenatal exposure by trimester of pregnancy was then collected from the patients' mothers' charts. The children's perinatal histories and ophthalmologic findings were collected from their pediatric clinic charts and ophthalmology clinic charts, respectively. RESULTS A total of 210 children with prenatal methadone exposure were identified, of whom 32 (15.2%) underwent eye examinations and 21 (10%) had strabismus. Five patients had esodeviations, with a mean age of onset of 11.6 months; 16 had exodeviations, with a mean age of onset of 6.8 months. Three patients with strabismus were born prematurely, and 2 had intracranial disease. Two patients underwent strabismus surgery. CONCLUSIONS The incidence of strabismus in patients with prenatal methadone exposure was higher than in the general population (10% vs 3%-4%). Intermittent exotropia was the most common type of strabismus and presented earlier than in the general population, with no association with other systemic disease. Prenatal exposure to methadone was likely confounded by exposure to other substances, environmental factors, and genetics. Poor compliance with follow-up reduced the power of the study.
Collapse
Affiliation(s)
- Sylvia H Yoo
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts.
| | - Lauren M Jansson
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland
| | | |
Collapse
|
22
|
Mactier H. Commentary on Gibson et al. (2017): Gestational age and the severity of neonatal abstinence syndrome. Addiction 2017; 112:717-718. [PMID: 28261981 DOI: 10.1111/add.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Helen Mactier
- Neonatal Unit, Princess Royal Maternity and the University of Glasgow, Glasgow, UK
| |
Collapse
|
23
|
Uebel H, Wright IM, Burns L, Hilder L, Bajuk B, Breen C, Abdel-Latif ME, Feller JM, Falconer J, Clews S, Eastwood J, Oei JL. Reasons for Rehospitalization in Children Who Had Neonatal Abstinence Syndrome. Pediatrics 2015; 136:e811-20. [PMID: 26371197 DOI: 10.1542/peds.2014-2767] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS. METHODS Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1,018,421 live born infants without an NAS diagnosis. RESULTS Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poisoning (3.6, 2.6-4.8), and mental/behavioral (2.6, 2.1-3.2) and visual (2.9, 2.5-3.5) disorders. Mothers of infants with NAS were more likely to be Indigenous (6.4, 6.0-7.0), have no antenatal care (6.6, 5.9-7.4), and be socioeconomically deprived (1.6, 1.5-1.7). Regression analyses demonstrated that NAS was the most important predictor of admissions for maltreatment (odds ratio 4.5, 95% confidence interval: 3.4-6.1) and mental and behavioral disorders (2.3, 1.9-2.9), even after accounting for prematurity, maternal age, and Indigenous status. CONCLUSIONS Children with NAS are more likely to be rehospitalized during childhood for maltreatment, trauma, and mental and behavioral disorders even after accounting for prematurity. This continues to adolescence and emphasizes the critical need for continued support of this vulnerable group after resolution of NAS.
Collapse
Affiliation(s)
- Hannah Uebel
- School of Women's and Children's Heath, University of New South Wales, Kensington, Australia
| | - Ian M Wright
- Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, Australia; Department of Paediatrics, The Wollongong Hospital, Wollongong, Australia
| | - Lucy Burns
- National Drug and Alcohol Research Centre, and
| | - Lisa Hilder
- National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Sydney, Australia
| | | | | | - Mohamed E Abdel-Latif
- Department of Neonatology, The Canberra Hospital, Garran, Australia; Faculty of Medicine, Australian National University, Deakin, Australia
| | - John M Feller
- School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Sydney Children's Hospital, Randwick, Australia
| | | | | | - John Eastwood
- School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Sydney Local Health District, Australia; School of Public Health, University of Sydney, Camperdown, Australia; and
| | - Ju Lee Oei
- School of Women's and Children's Heath, University of New South Wales, Kensington, Australia; Department of Newborn Care, Royal Hospital for Women, Randwick, Australia
| |
Collapse
|
24
|
Chakraborty A, Anstice NS, Jacobs RJ, Paudel N, LaGasse LL, Lester BM, Wouldes TA, Harding JE, Thompson B. Global motion perception is independent from contrast sensitivity for coherent motion direction discrimination and visual acuity in 4.5-year-old children. Vision Res 2015; 115:83-91. [PMID: 26318529 PMCID: PMC4587337 DOI: 10.1016/j.visres.2015.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/28/2015] [Accepted: 08/22/2015] [Indexed: 01/25/2023]
Abstract
Global motion processing depends on a network of brain regions that includes extrastriate area V5 in the dorsal visual stream. For this reason, psychophysical measures of global motion perception have been used to provide a behavioral measure of dorsal stream function. This approach assumes that global motion is relatively independent of visual functions that arise earlier in the visual processing hierarchy such as contrast sensitivity and visual acuity. We tested this assumption by assessing the relationships between global motion perception, contrast sensitivity for coherent motion direction discrimination (henceforth referred to as contrast sensitivity) and habitual visual acuity in a large group of 4.5-year-old children (n=117). The children were born at risk of abnormal neurodevelopment because of prenatal drug exposure or risk factors for neonatal hypoglycemia. Motion coherence thresholds, a measure of global motion perception, were assessed using random dot kinematograms. The contrast of the stimuli was fixed at 100% and coherence was varied. Contrast sensitivity was measured using the same stimuli by fixing motion coherence at 100% and varying dot contrast. Stereoacuity was also measured. Motion coherence thresholds were not correlated with contrast sensitivity or visual acuity. However, lower (better) motion coherence thresholds were correlated with finer stereoacuity (ρ=0.38, p=0.004). Contrast sensitivity and visual acuity were also correlated (ρ=-0.26, p=0.004) with each other. These results indicate that global motion perception for high contrast stimuli is independent of contrast sensitivity and visual acuity and can be used to assess motion integration mechanisms in children.
Collapse
Affiliation(s)
- Arijit Chakraborty
- School of Optometry and Vision Science, University of Auckland, New Zealand
| | - Nicola S Anstice
- School of Optometry and Vision Science, University of Auckland, New Zealand
| | - Robert J Jacobs
- School of Optometry and Vision Science, University of Auckland, New Zealand
| | - Nabin Paudel
- School of Optometry and Vision Science, University of Auckland, New Zealand
| | - Linda L LaGasse
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University, USA
| | - Barry M Lester
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University, USA
| | - Trecia A Wouldes
- Department of Psychological Medicine, University of Auckland, New Zealand
| | | | - Benjamin Thompson
- School of Optometry and Vision Science, University of Auckland, New Zealand; School of Optometry and Vision Science, University of Waterloo, Canada.
| |
Collapse
|
25
|
Infants of opioid-dependent mothers: neurodevelopment at six months. Early Hum Dev 2015; 91:19-21. [PMID: 25460252 DOI: 10.1016/j.earlhumdev.2014.10.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study is to describe infant neurodevelopment in 81 infants of methadone-prescribed opioid-dependent mothers. METHODS Griffith MD scores at six months. RESULTS Scores were lower in all domains compared to controls (p<0.001). Poly-drug exposed infants and those treated for neonatal abstinence syndrome performed significantly poorer (p=0.002 and p=0.008 respectively). CONCLUSIONS Infants of methadone-maintained opioid-dependent mothers show poorer neurodevelopment at six months of age than non-drug exposed comparison infants. Developmental difficulties are confounded by delayed visual development. PRACTICE IMPLICATIONS These highly vulnerable children merit close surveillance throughout infancy. SUMMARY Griffith MD scores at six months in 81 infants born to methadone-prescribed opioid-dependent mothers were lower in all domains compared to controls (p<0.001). Poly-drug exposed infants and those treated for neonatal abstinence syndrome performed significantly poorer (p=0.002 and p=0.008 respectively). Co-existing visual problems were common.
Collapse
|
26
|
A VEP study in sleeping and awake one‐month‐old infants and its relation with social behavior. Int J Dev Neurosci 2014; 41:37-43. [DOI: 10.1016/j.ijdevneu.2014.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
|
27
|
Yuan Q, Rubic M, Seah J, Rae C, Wright IMR, Kaltenbach K, Feller JM, Abdel-Latif ME, Chu C, Oei JL. Do maternal opioids reduce neonatal regional brain volumes? A pilot study. J Perinatol 2014; 34:909-13. [PMID: 24945162 DOI: 10.1038/jp.2014.111] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/18/2014] [Accepted: 04/21/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE A substantial number of children exposed to gestational opioids have neurodevelopmental, behavioral and cognitive problems. Opioids are not neuroteratogens but whether they affect the developing brain in more subtle ways (for example, volume loss) is unclear. We aimed to determine the feasibility of using magnetic resonance imaging (MRI) to assess volumetric changes in healthy opioid-exposed infants. STUDY DESIGN Observational pilot cohort study conducted in two maternity hospitals in New South Wales, Australia. Maternal history and neonatal urine and meconium screens were obtained to confirm drug exposure. Volumetric analysis of MRI scans was performed with the ITK-snap program. RESULT Scans for 16 infants (mean (s.d.) gestational age: 40.9 (1.5) weeks, birth weight: 3022.5 (476.6) g, head circumference (HC): 33.7 (1.5 cm)) were analyzed. Six (37.5%) infants had HC <25th percentile. Fourteen mothers used methadone, four used buprenorphine and 11 used more than one opioid (including heroin, seven). All scans were structurally normal whole brain volumes (357.4 (63.8)) and basal ganglia (14.5 (3.5)) ml were significantly smaller than population means (425.4 (4.8), 17.1 (4.4) ml, respectively) but lateral ventricular volumes (3.5 (1.8) ml) were larger than population values (2.1(1.5)) ml. CONCLUSION Our pilot study suggests that brain volumes of opioid-exposed babies may be smaller than population means and that specific regions, for example, basal ganglia, that are involved in neurotransmission, may be particularly affected. Larger studies including correlation with neurodevelopmental outcomes are warranted to substantiate this finding.
Collapse
Affiliation(s)
- Q Yuan
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - M Rubic
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - J Seah
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - C Rae
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - I M R Wright
- Graduate School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - K Kaltenbach
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - J M Feller
- 1] School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia [2] Department of Paediatrics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - M E Abdel-Latif
- 1] Department of Neonatology, Centenary Hospital for Women and Children, Canberra, ACT, Australia [2] School of Clinical Medicine, Australian National University, Woden, ACT, Australia
| | - C Chu
- Department of Radiology, The Wollongong Hospital, Wollongong, NSW, Australia
| | - J L Oei
- 1] School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia [2] Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia
| | | |
Collapse
|
28
|
Abstract
Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.
Collapse
Affiliation(s)
- Prabhakar Kocherlakota
- Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital at New York Medical College, Valhalla, New York
| |
Collapse
|
29
|
Mozurkewich EL, Rayburn WF. Buprenorphine and methadone for opioid addiction during pregnancy. Obstet Gynecol Clin North Am 2014; 41:241-53. [PMID: 24845488 DOI: 10.1016/j.ogc.2014.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Buprenorphine and methadone are opioid-receptor agonists used as opioid substitution therapy during pregnancy to limit exposure of the fetus to cycles of opioid withdrawal and reduce the risk of infectious comorbidities of illicit opioid use. As part of a comprehensive care plan, such therapy may result in improved access to prenatal care, reduced illicit drug use, reduced exposure to infections associated with intravenous drug use, and improved maternal nutrition and infant birth weight. This article describes differences in patient selection between the two drugs, their relative safety during pregnancy, and changes in daily doses as a guide for prescribing clinicians.
Collapse
Affiliation(s)
- Ellen L Mozurkewich
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - William F Rayburn
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM 87131, USA
| |
Collapse
|
30
|
McGlone L, Hamilton R, McCulloch DL, MacKinnon JR, Bradnam M, Mactier H. Visual outcome in infants born to drug-misusing mothers prescribed methadone in pregnancy. Br J Ophthalmol 2013; 98:238-45. [DOI: 10.1136/bjophthalmol-2013-303967] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
31
|
Abstract
Substance misuse in pregnancy is not a new problem, but although impaired foetal growth and the risk of developing neonatal abstinence syndrome are widely appreciated, relatively little attention has been paid to longer term consequences for the infant. Available evidence indicates that prenatal exposure to opioids and other drugs of misuse is detrimental to the developing foetal brain; consistent with this, poor in utero head growth, delayed infant visual maturation and impaired general neurodevelopmental progress independent of social confounders are increasingly being recognised. This review considers current evidence and discusses best practice in the neonatal management and follow-up of affected babies. More studies are required to explore alternatives to methadone maintenance in pregnancy and to define optimal treatment for neonatal abstinence syndrome. All infants born to drug-misusing mothers must be considered vulnerable, even if they have not required treatment for neonatal abstinence syndrome.
Collapse
Affiliation(s)
- Helen Mactier
- Neonatal Unit, Princess Royal Maternity, 8-16, Alexandra Parade, Glasgow G31 2ER, United Kingdom; NHS Greater Glasgow and Clyde, United Kingdom; The University of Glasgow, United Kingdom.
| |
Collapse
|
32
|
Tinelli F, Gamucci A, Battini R, Cioni G. Congenital nystagmus in two infants born from mothers exposed to methadone during pregnancy. Ital J Pediatr 2013; 39:40. [PMID: 23822191 PMCID: PMC3726377 DOI: 10.1186/1824-7288-39-40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/28/2013] [Indexed: 11/11/2022] Open
Abstract
Background Methadone is commonly prescribed as a substitute for illicit opioids. Use of methadone during pregnancy is associated with neonatal abstinence syndrome (NAS), reduced head circumference as well as a slight increase in neonatal mortality and morbidity. Less is known about the effects of methadone on the visual system. Cases We report two Italian cases of nystagmus in infants born from mothers exposed to methadone during pregnancy. Ophthalmic or central disorders were excluded as a cause of nystagmus in both infants. The first case was followed at 3, 6 and 12 months while the second one was evaluated at 5 and 8 months. Both infants had normal neurological and cognitive development. Their first evaluation revealed different characteristics but both showed progressive improvement in ocular disorder, persistence of pendular horizontal nystagmus and nearly normal visual acuity. Conclusion This report, the first description of Italian cases of nystagmus related to use of methadone during pregnancy, underlies the importance of a careful investigation of drug use in pregnancy in cases of unexplained congenital nystagmus.
Collapse
|