Prenatal opioid exposure increases the risk of infants dying before their first birthday, according to a recent study in JAMA Pediatrics.

Neonatal opioid withdrawal affects about 20,000 newborns each year, with hospital stays averaging 16 to 19 days and national health care costs exceeding $500 million annually. The researchers wanted to learn more about outcomes in infants not diagnosed with opioid withdrawal, as well as outcomes after leaving the hospital.

The population-based retrospective cohort study used data from the Texas Neonatal Intensive Care Project developed by Texas Health and Human Services. After applying inclusion and exclusion criteria, the researchers analyzed more than 1 million records.

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Infants diagnosed with withdrawal syndrome were found most likely to experience preterm delivery, congenital abnormalities and small size for gestational age. However, the infant mortality rate was highest in infants not diagnosed with withdrawal syndrome (20 per 1,000 live births) followed by infants with a history of withdrawal syndrome (11 per 1,000 live births), and the reference group (6 per 1,000 live births).

While the racial and ethnic diversity of the study was a strength, absence of pharmacy claims data was a limitation. Other limitations include the inability to analyze hospital length of stay, post-discharge health care use, and custody status.

“The findings of our study suggest that opioid-exposed infants are at increased risk of mortality during infancy, and the constellation of treatments and supports provided to infants diagnosed with [neonatal opioid withdrawal syndrome] may be protective,” the study researchers conclude. “Clinical interventions, public health programs, and health policy to support women with [opioid use disorder] and their infants appear to be warranted, regardless of the perceived severity of neonatal opioid withdrawal.”

Disclosures:Several authors reported receiving grants from various nonprofit health organizations. Please see the original document for full disclosures.


Leyenaar JK, Schaefer AP, Wasserman JR, Moen EL, O’Malley AJ, Goodman DC. Infant mortality associated with prenatal opioid exposureJAMA Pediatr. Published online April 12, 2021. doi:10.1001/jamapediatrics.2020.6364

This article originally appeared on Psychiatry Advisor