Identifying Potential Factors Associated With Growth Problems in Infants With Prenatal Substance Exposure

Objectives: The current study extends research on prenatal substance exposure (PSE) and infant growth by systematically examining exposure to various substances and applying multi-level modeling (MLM) to evaluate the impact of PSE, feeding issues, and gastrointestinal issues on infant weight across the first three years of life to identify factors associated with growth problems. Methods: A retrospective chart review (2017-2020) of infants with PSE (n=240) and infants without PSE (n = 209) was conducted. Over five thousand weights from the first four years were extracted. MLM was used to estimate how infant weight changed over time and whether PSE, feeding issues, or gastrointestinal issues predicted different growth trajectories over time. Weight data were fit according to the following model taxonomy: Model A was the unconditional means model and Model B was the unconditional growth model. Models C-H sequentially added level 2 predictor variables one at a time as additional predictors to the unconditional growth model. Model I removed non-significant fixed and random effects. Results: For the final model, weights at time 0 (birth) for infants without substance exposure or feeding or gastrointestinal issues were estimated to be 4.33 kgs, on average. Infants with opioid, THC, or benzodiazepine substance exposure had lower estimated birth weights. Infants born premature also had lower estimated birth weights. As expected, infant weights significantly increased with age. However, this increase was predicted to be significantly less for infants with prenatal opioid exposure. Estimated infant weights did not significantly change over time with the presence of feeding issues or gastrointestinal issues. Conclusions: Symptoms in neonates with opioid withdrawal include feeding and GI complications; both may impact nutrient intake and utilization. With growth among infants with opioid exposure continuing to falter over the first 3 years, identifying the reason has the potential to improve practice, and enhance developmental outcomes. Ongoing research includes efforts to standardize clinical documentation of symptoms for future analysis. Funding Sources: There are no funding sources to report.