211 - Case series of severe oral feeding difficulties in infants with neonatal opioid withdrawal syndrome

Poster Number: 211
Publication Number: 211.370

Background: Neonatal opioid withdrawal syndrome (NOWS) affects multi-organ systems and is associated with generalized irritability, altered sensitivity to stimuli, and feeding difficulties. Despite adequate and reasonable pharmacological management, some infants develop a persistent struggle with oral feeds and require prolonged hospital stay. Contributing factors to such oral feeding difficulty are not well studied.

Objective: To examine common variables that predispose infants with NOWS to severe oral feeding difficulties.

Design/Methods: This study was a retrospective case series at three academic tertiary hospitals in the Northeast US. Inclusion criteria were infants with NOWS born between January 1, 2017, and December 31, 2021, with gestational age (GA) >35 weeks, had a length of stay (LOS) >30 days, required a nasogastric or gastrostomy tube for feeding difficulty. Infants with congenital anomalies or genetic syndromes were excluded. Data collected include maternal and infant demographics, opioid exposures during pregnancy, NOWS pharmacological treatment, discharge metrics, and detailed feeding data and evaluations. Continuous data were analyzed using a student’s t-test and categorical data using a Chi-squared test.

Results: A total of 20 infants were included with a mean GA of 37.6 weeks (SD ± 1.9), 70% White, 55% male, and mean LOS of 41.9 days (SD ± 16.4) (Table 1). Infants reached full oral feeds on mean day of life (DOL) 50.2 (SD ± 62.6) with a mean length of treatment for NOWS of 23.7 days (SD ±13.8). Time to reach full oral feeds was associated with maternal alcohol use (p=0.04). Other variables evaluated for association with duration to full PO feeds that showed increases were methadone exposure (p=0.18), male sex (p=0.2), and exclusive formula feeding (p=0.05). Additional variables of interest are listed in Table 2.

Conclusion(s): While our study is limited by a small sample size, our data demonstrated that the presence of maternal alcohol use is associated with poor oral feeding in infants with NOWS. Understanding factors related to prolonged time to achieve full oral feeds has the potential to target interventions that may prevent or alleviate oral feeding difficulties, reduce LOS, and minimize overutilization of medical resources in this population.