Abstract
Previous studies have not found structural injury or brain malformations in infants and children with prenatal opioid exposure. As part of an ongoing study evaluating neuroimaging in infants with prenatal opioid exposure, we reviewed structural brain MR imaging in 20 term infants with prenatal opioid exposure and 20 term controls at 4-8 weeks of age. We found that 8 of the 20 opioid-exposed infants had punctate white matter lesions or white matter signal abnormality on structural MR imaging, and 2 of the opioid-exposed infants had a septopreoptic fusion anomaly. No controls had white matter injury or structural malformations. Our findings underscore the importance of clinical neurodevelopmental follow-up and the need for more comprehensive imaging and long-term outcomes research following prenatal opioid exposure.
Highlights
Eight of the 20 infants (40%) with prenatal opioid exposure had punctate foci of white matter injury or more diffuse white matter injury seen on the initial clinical read by the radiologist
White matter injury is described most commonly in infants born preterm, but it can occur in full-term infants who sustain in utero insults during a susceptible period of white matter development.[15]
Punctate white matter lesions have been reported in term and late-preterm infants with congenital heart there is no increase in macrostructural injury compared with controls.[1,2]
Summary
As part of an ongoing prospective cohort study on functional brain connectivity in infants with opioid exposure, we acquired structural MR imaging in 4- to 8-week-old infants with confirmed prenatal opioid exposure and unexposed healthy term controls. Inclusion criteria for the opioid-exposed group included infants $37 weeks’ gestation with known exposure to maternal buprenorphine or methadone during pregnancy and no known prenatal alcohol exposure. Inclusion criteria for controls were infants of $37 weeks’ gestation with no opioid, alcohol, or illicit drug exposure during pregnancy confirmed by maternal urine toxicology screen and maternal history. Exclusion criteria for both groups included a 5-minute Apgar score of ,7, any need for positive pressure ventilation at any time after birth, head trauma, and known chromosomal or congenital anomalies potentially affecting the central nervous system. The MR imaging scores were based on all 4 sequences (T1, T2, DWI, and SWI)
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