To characterize the weight trajectories of opioid-exposed infants and evaluate the association between different exposures and risk of excessive neonatal weight loss. Using mother-baby linked electronic health records, vital records, and claims data, we identified a retrospective cohort of opioid-exposed infants born at a large, academic medical center (2010-2021). We characterized prenatal substance exposures 90 to 2 days before delivery, including medications for opioid use disorder (MOUD), non-MOUD opioids, selective serotonin reuptake inhibitors, benzodiazepines, gabapentin, cigarette smoking, and toxicology evidence of opioids and non-opioid exposures (e.g., barbiturates, cannabinoids, amphetamines, cocaine). We parameterized neonatal weight loss as the maximum percentage decrease from birthweight in the first 14 days of life during birth hospitalization. We used multivariable linear regression to compare the association between prenatal exposures and maximum percentage weight loss. Among 868 opioid-exposed maternal-infant dyads identified, 622 (71.7%) had prenatal exposure to at least one additional substance. Infants with additional prenatal exposures had a greater median weight loss and a later nadir in weight loss compared to those without additional exposures (p<0.001). In analyses examining individual substances, MOUD prescriptions (coefficient: 0.99; 95% CI: 0.50-1.48) and positive toxicology for non-opioid drugs (coefficient: 0.53; 95% CI: 0.08-0.98) were associated with a greater maximum percentage weight loss Exposure to MOUD and non-opioid exposures were associated with greater weight loss among opioid-exposed infants during the first 14 days of life. These findings inform the clinical management of opioid-exposed infants to mitigate weight loss during the neonatal hospitalization.
Andersen et al. (Sun,) studied this question.