517 Racial differences in modified finnegan neonatal abstinence scoring for neonatal opioid withdrawal syndrome

Abstract

Neonates exposed in-utero to opioids are commonly evaluated for neonatal opioid withdrawal syndrome (NOWS) using modified Finnegan Neonatal Abstinence Scoring System (FNASS). FNASS includes 21 different components of central nervous system, metabolic, vasomotor, respiratory, and GI disturbances. Consecutive cumulative scores ≥8 are suggestive for starting pharmacologic treatment. Our objective was to identify significant differences in FNASS scoring in neonates stratified by race. Retrospective cohort study of patients with opioid use disorder (OUD) who received co-located prenatal and addiction care from 2013 to 2020 at a large academic institution. Non-Hispanic Black (NHB) patients were matched to non-Hispanic White (NHW) patients by year and gestational age at delivery. Race and ethnicity were self-reported by the mother. The primary outcome was differences in individual scoring components. 42 NHB mother-newborn dyads were compared to 42 matched NWH dyads. There were no significant differences in baseline demographics between the groups. NHB newborns were significantly less likely than NHW to be scored for observed red, blotchy skin changes consistent with skin mottling (79% vs 100%, P<0.01). All NHB and NHW newborns were scored for mild tremors when disturbed and increased muscle tone; there were no significant scoring differences in the remaining FNASS components. NHB newborns were less likely to receive a FNASS ≥8 (69% vs. 81%, RR 0.85, CI 0.66-1.09) compared to NHW infants, and to receive pharmacological treatment for NOWS (76% vs. 98%, RR 0.78, CI 0.66-0.93) compared with NHW newborns. However, within this cohort of NHB newborns, receiving a score for mottling would have resulted in earlier and/or increased rates of pharmacologic treatment for NOWS in 36% (n=15) of patients. Infants born to NHB patients were less likely to receive score for skin mottling on modified FNASS. Lack of recognition of mottling maybe due to skin pigmentation differences and could potentially result in underscoring and delay of pharmacological treatment for NOWS.