About 2/3 of children with asthma had been exposed to opioids prior to birth, according to a new retrospective study.
The results underscore the necessity of maintaining close follow up care in this vulnerable patient population.
In the past 10 years, prenatal opioid exposure (POE) has seen a dramatic increase among the US newborn population. As many as 100 infants are born daily with Neonatal Opioid Withdrawal Syndrome (NOWS). Therefore, there lies a great need in investigating long-term outcomes in such patients.
Isabella Cervantes, BA, of the University of New Mexico School of Medicine, and colleagues designed a retrospective cohort study to determine the association between POE and the likelihood of an altered immune response by 8 years of age. Immune response was measured by the development of asthma.
To do this. Cervantes and team pulled data from a comprehensive CERNER HealthFacts® U.S. national database, which captures de-identified, longitudinal health record data from 800 hospitals across the country.
The investigators used ICD-9-CM and ICD-10-CM diagnostic codes to identify infant patients born at term who had confirmed prenatal exposure to opioids or Neonatal Opioid Withdrawal Syndrome (NOWS).
Then they compared this population of patients with infants who had neither diagnoses at birth. Data was analyzed using IBM Statistical Package for Social Sciences, and Pearson’s Chi-Square test analysis was conducted to determine any association between POE and asthma diagnosis.
Overall, the study included 3021 patient records between 2000-2016. A majority of the population was male (50.7%), with Caucasian (61%) being the most represented race/ethnicity.
The investigators also noted that a majority of patients had Medicaid insurance (41.9%) and were raised in urban communities (92.5%).
As many as 50.4% of patients presented with POE—versus 49.6% who had no known exposure.
In their analysis, the investigators found that up to 66.3% of all asthma patients (n = 172) were prenatally exposed to opioids.
Thus, after controlling for race, gender demographics, and insurance type, they determined that the odds of developing asthma were two times higher for the prenatally exposed group (OR, 21; 95% CI, 1.4-3.0; P<.0001) than those who did not have POE.
They considered a major strength of the study to be the vastness of the national database. Therefore, the results could be consistent across different regions in the US.
A limitation, however, were the diagnostic codes used to identify their patient population of interest. For example, the codes used to identify infants with prenatal opioid exposure included other diagnoses such as Drug Withdrawal Syndrome in Newborn. Other confounding variables included smoking in the household, among others.
To address such limitations, they highlighted a need to undertake a longitudinal, prospective, multisite study for the future.
“These emerging results suggest infants with POE may have altered immune reactivity that not only impacts the newborn period but persists into childhood,” they wrote.
Future investigations should aim to characterize in greater detail the impact of POE on the immune system so that new follow-up strategies or effective interventions can be developed, they concluded.
The study, Increased Incidence of Asthma in Children with Prenatal Opioid Exposure, was published online in The Univeristy of New Mexico Digital Repository.