Racial differences in opioid withdrawal syndrome among neonates with intrauterine opioid exposure

Background The aim of this study was to investigate the association between race and severe neonatal opioid withdrawal syndrome (NOWS) in infants exposed to intrauterine opioids. Methods This is a prospective observational study on intrauterine opioid-exposed term infants. Exposure to opioids was based on maternal disclosure, urine, or umbilical cord drug screening. Severe NOWS was defined based on modified Finnegan scoring and the need for pharmacological intervention. Results One hundred and fifty mother-infant pairs, 60 Black and 90 White with history of opioid exposure during pregnancy, were included. More White than Black infants developed NOWS that required pharmacological treatment, 70 vs. 40%: RR = 1.75 (1.25-2.45). In adjusted analysis, there was no significant association between race and the development of severe NOWS in mothers who attended opioid maintenance treatment program (OMTP). However, in mothers who did not attend OMTP, White race remained a significant factor associated with the development of severe NAS, RR = 1.69 (1.06, 2.69). Conclusions Severe NOWS that required pharmacological intervention was significantly higher in White than in Black infants born to mothers who did not attend OMTP. Larger studies are needed to evaluate the association between social as well as genetic factors and the development of NOWS. Impact There is a significant association between race and development of severe NOWS.

Automated summary

There is a significant association between race and the development of severe neonatal opioid withdrawal syndrome (NOWS). White infants born to mothers who did not attend opioid maintenance treatment program (OMTP) had a higher rate of severe NOWS requiring pharmacological intervention compared to Black infants. Larger studies are needed to further explore the association between social and genetic factors and the development of NOWS.