Neonatal Abstinence Syndrome: A Systematic Review and Meta-Analysis of Neurocognitive Outcomes for Infants Born with Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a group of physiological symptoms that arise due to opiate withdrawal at birth. NAS is an expanding problem with studies suggesting an increase in NAS incidence in the United States. Infants prenatally exposed to opioids have been associated with negative health outcomes for infants and mothers, but its long-term neurologic development remains unknown. This study examined the association between prenatal exposure to opioids and cognitive development in children from ages 3 months to 18 years. A literature review was conducted using several electronic databases and searched terms: neonatal abstinence syndrome and neurocognitive development. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data was pooled using a random-effects model. The study’s significance was to gain an increased understanding of the long-term effects of prenatal exposure to opioids and determine whether an association exists between children with NAS and neurocognitive outcomes. Greater understanding can help in establishing recommendations for long-term care and special education supports necessary to improve their outcomes. The meta-analysis employs a statistical approach that integrates the results from multiple studies by which we can address issues with small sample sizes, increase power, improve the estimates of the size of the effect and help resolve the inconsistent findings. The main outcomes included standardized mean differences in General Cognition, Verbal Functioning, and Executive Functioning. Eighty-three peer reviewed studies were included. General Cognitive, Verbal Functioning, and Executive Functioning were compared between exposed and non-exposed children as well as testing norms. Results of this meta-analysis indicated significant differences in General Cognitive, Verbal Functioning, and Executive Functioning when comparing exposed and non-exposed groups. On average, there were poorer neurocognitive outcomes for children prenatally exposed to opioids, including infants diagnosed with neonatal abstinence syndrome. The standardized mean difference was lower in General Cognition tests for children with prenatal exposure to opioids (g = −0.685; 95% CI, −0.829 to −0.541; p < .001) Verbal Functioning (g = -.558; 95% CI, -.810 to -.306; p <.001), and Executive Functioning (g = -.303; 95% CI, -.494 to -.111, p < .01). Overall, these findings supported the primary hypothesis and previous literature that children with a history of NAS would perform poorer than non-exposed children. Hypothesized moderators, including neonatal medical variables and medication assisted treatment did moderate the relationship between prenatal opioid exposure and neurocognitive outcomes. Specifically, children with NAS and with more medically complex variables (e.g., lower birthweight) performed poorer than their non-exposed peers. Closer review of type of opioid exposure and neurocognitive outcomes yielded several significant exposures associated with lower neurocognitive outcomes and neonatal medical variables. Taken together, children born to opioid-dependent mothers are at modest- to high-risk of adverse neurocognitive development. Future studies should identify specific clinical and social factors underlying these challenges to improve outcomes.

Grantor dc:publisher

University of Kansas

Year dc:date.issued

2022

Author dc:creator

• Garcia, Andrea Magdalena

Advisor dc:contributor.advisor

• Niileksela, PhD, Christopher

• Health sciences
• Meta-Analysis
• Neonatal Abstinence Syndrome
• Neurocognitive Functioning
• Pediatric Psychology

Statement dc:rights

• Copyright held by the author.

Language dc:language.iso

en

Dc Identifier Other

http://dissertations.umi.com/ku:18575

OAI identifier oai:identifier

oai:kuscholarworks.ku.edu:1808/39013