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61 The effect of in utero polysubstance exposure on length of stay and length of pharmacologic treatment compared with opioids alone

Purpose of study Many studies have evaluated the efficacy of different inpatient treatment protocols on length of stay (LOS) in neonates with prenatal exposure to opioids but polysubstance is often excluded. In our institution, 77% of neonates who received neonatal withdrawal inventory (NWI) scoring had polysubstance exposure over opioids alone. We hypothesised that neonates with polysubstance exposure would have a prolonged overall LOS, LOS requring pharmacologic treatment, and length of pharmacologic treatment (LOT) compared to opioids alone because of the synergistic disturbance on the CNS with multiple classes of drugs. Methods used A retrospective review of 191 infants admitted to our NBICU or newborn nursery between 4/2015- 4/2017 who received any NWI scoring was completed. We collected maternal exposures, infant demographics (sex, gestational age, and others), overall LOS, LOS requiring pharmacologic treatment, and LOT. Substance exposures were categorised as: opioids alone, opioids+stimulant, opioids+cannabinoid or sedative or SSRI, opioids+≥2 drug classes, and non-opioid exposure. Iatrogenic withdrawal was excluded. Summary of results A total of 142 infants met inclusion criteria. The overall LOS with the 15 infants exposed to opioids alone was 19.1±21.3 days, the LOS requiring morphine was 20.7±9.9 days, and LOT was 12.3±4.9 days. The opioids+stimulant group had the shortest overall LOS compared to the overall LOS with opioids alone (11.1±8.4 days, n=45, p<0.05). There was no statistical difference in LOS requiring morphine treatment nor in the LOT across all other exposure groups. Conclusions Contrary to our hypothesis, we found no difference in overall LOS except for opioids+stimulant group which decreased overall LOS. We also found no difference in LOT, suggesting the overall decrease in LOS in the opioids+stimulant group may be due to other confounding factors such as unequal distribution of prematurity, high variability within other groups, and small sample size in opioids alone. Our data suggest that providers may anticipate a similar LOS in infants with polysubstance exposure who require pharmacologic treatment and may validate the reason for excluding polysubstance exposed infants in previous studies.