(77) Associations of Neurobehavioral Problems with Developmental Outcomes in a Prospective Cohort of Children with Neonatal Opioid Withdrawal Syndrome

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

Objectives: 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 infants with NOWS. Inclusion criteria: gestational age ≥34 weeks with in-utero opioid exposure and pharmacologic treatment for NOWS. Exclusion: major congenital or genetic anomalies. Outcomes assessed between 2-3 years of age using the Bayley Scales of Infant and Toddler Development (Bayley, 3rd or 4th ed) 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 percentiles, with higher scores reflecting more problem behaviors. Linear regression models estimated the difference in Bayley scores by CBCL classification; models adjusted for maternal education, gestational age, birthweight, and guardian status at discharge. The study was IRB approved; informed consent was obtained from the legal guardian.

Results: We enrolled 205 infants from 2018 to 2020 (Fig 1). Pregnant person and infant characteristics are presented in Table 1. All infants had in utero exposure to opioids; 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 all domains (Table 2). ‘Borderline’ or ‘clinical’ level symptoms on the internalizing, withdrawn, and autism spectrum problems scales of the CBCL correlated with lower scores in all categories on all Bayley scales in both unadjusted and adjusted analyses.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 with lower Bayley cognitive scores (Table 3).

Conclusions: 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.