201 - Does in-utero exposure to Selective Serotonin Receptor Inhibitors (SSRI) affect severity of Neonatal Opioid Withdrawal Syndrome (NOWS)?

Poster Number: 201
Publication Number: 201.333

Saminathan Anbalagan, Thomas Jefferson University, Wilmington, DE, United States; Victoria A. Anderson, Sidney Kimmel Medical College at Thomas Jefferson University, Moorestown, NJ, United States; Michael T. Favara, Sidney Kimmel Medical College at Thomas Jefferson University, MEDIA, PA, United States; Daniela Stark, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; David Carola, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Kolawole O. Solarin, NemoursAlfred I. duPont Hospital for Children/Thomas Jefferson University Hospital, Philadelphia, PA, United States; Susan Adeniyi-Jones, Sidney Kimmel Medical College at Thomas Jefferson University, Wynnewood, PA, United States; Zubair Aghai, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States

Background: Selective Serotonin Receptor Inhibitors (SSRI) like sertraline are the most common medications for depression among women with opioid use disorder. Literature shows conflicting information about SSRI’s effect on short-term outcomes in neonates with Neonatal Opioid Withdrawal Syndrome (NOWS) (Bakhireva LN, 2022) (Huybrechts KF, 2017).

Objective: To assess the severity of NOWS among those with SSRI co-exposure in-utero and compare it with infants with NOWS without SSRI co-exposure in-utero.

Design/Methods: Retrospective analysis of infants born in a level 3 NICU in Philadelphia and admitted for NOWS treatment with medical therapy between August 2006 and August 2022. Term and late preterm infants (≥35 weeks gestation) were included. Various maternal (e.g. demographics, SSRI intake, type of opioids used, multiple drugs, smoking) and infant characteristics (e.g. gestational age, gender, anthropometrics) were obtained. The severity of NOWS, as reflected by the length of treatment (LOT), length of stay (LOS) in the hospital, and need for additional medications (phenobarbital and clonidine), were compared between NOWS+SSRI exposed cohort vs. NOWS only. Groups were compared using chi-square and Mann-Whitney tests, and regression analysis was performed to adjust for baseline differences and confounders (small for gestational age status and maternal benzodiazepine use).

Results: A total of 1074 mother-infant dyads were included in the analysis, with 12.8% in the NOWS+SSRI cohort. Baseline clinical characteristics did not differ between groups except for the type of delivery, 5 min Apgar score, maternal methadone dose (in mg), benzodiazepine, and polysubstance use in numbers (Table 1). No statistical differences in LOT (median: 26 days vs. 24 days, p=0.35) and LOS (median: 32 days vs. 29 days, p=0.18) were identified between the two groups (Table 2). This finding was retained even in adjusted linear regression analysis. Infants in the NOWS+SSRI group were more likely to need the additional medication phenobarbital (Table 2), although this did not reach statistical significance in adjusted logistic regression analysis [OR 1.26; 95% CI: 0.79-2.04].

Conclusion(s): This study did not find statistical differences in LOT and LOS between infants treated for NOWS secondary to opioid and SSRI co-exposure in-utero and infants treated for NOWS without SSRI co-exposure in-utero. These results could potentially impact decisions for depression treatment among mothers with opioid use.