Introduction Neonatal abstinence syndrome (NAS) is a health condition in infants that results from the sudden discontinuation of substances that infants were exposed to in utero (Kocherlakota, 2014). Typical symptoms include: hyperirritability, sweating, hypertension, tremors, sleep deprivation, and seizures (Kocherlakota, 2014). The role of a SLP in treating infants with NAS in the NICU includes evaluation, assessment, and treatment of the feeding cycle. Our research is an early exploratory and descriptive study of the pre-natal, peri-natal, and post-natal characteristics of infants with NAS who required SLP assessment and intervention as opposed to those who did not. Our aim was to examine possible predictors of infants with feeding and swallowing difficulties. Methods Data was collected from a local hospital system that conducted a five-year retrospective chart review study. From charts of 140 infants in the NICU, infants were placed into two groups: infants who received SLP services (SLP group) and infants who did not receive SLP services (NSLP group). From those charts, 26 infants with NAS who received SLP services were placed in SLP group based on the availability of a match in NSLP group. Infants in both groups were matched based on gestational age, year of birth, and gender. Results/Conclusion There were no significant differences found between SLP group and NSLP groups in: number of prenatal visits, week/timing of initial prenatal visit, and dosage of buprenorphine taken by the mother. The two groups did not differ (all ps>.18) in their types of drug use, average dosage of buprenorphine taken, average number of prenatal visits, or average week of first visit. There was a statistically significant difference in maternal age in the SLP group (p<.05; M=29.7 years, SD=5.4) and in NSLP group (M=26.7 years, SD=4.3.). There was no statistically significant difference in initial measurements of weight, head circumference, length, Apgar scores at birth, and number of complications between groups. There were no significant differences found in NAS scores between groups regarding the highest NAS score or average NAS score, number of NAS scores and first day of collection or number of days collected. There was a statistically significant difference in the number of prescription drugs administered. Infants in SLP group had more prescription drugs on average (M=1.50, SD=.89) than NSLP group (M=1.04, SD=.20). There was a statistically significant difference in the amount of weight gained (SLP group gained 229 more grams) and in infant length of stay and overall cost (SLP group on average stayed in the NICU one week longer and cost $22,896 more). Little research has been conducted regarding NAS and the impact it has on feeding and swallowing. We found that there are statistically significant differences among infants who were in SLP and NSLP groups. It cannot be determined how many full-term infants have dysphagia; however, from a clinical opinion it is thought that most full-term babies with dysphagia also have a neurological impairment.

Background: Neonatal Abstinence Syndrome (NAS), a manifestation of the widespread opioid epidemic, has plagued our country, and particularly the region of Northeast Tennessee, for quite some time now. One question among many that seems to baffle almost everyone involved in research on the topic at hand is that why do only 35-40% of opioid exposed pregnancies result in NAS requiring medication while sparing the rest. Is there some discriminatory factor other than in utero opioid exposure involved? Thus, in light of this knowledge, we wanted to investigate whether birth weight at the time of delivery can influence the development of NAS; that is, are neonates of a low birth weight or high birth weight (with respect to gestational age thresholds) more likely to develop NAS. Methods: Therefore, we conducted a retrospective chart analysis of all deliveries within the Mountain States Health Alliance System over a 5 years period between July 1, 2011- June 30, 2016 at all 5 delivery sites in Northeast Tennessee and Southwest Virginia (N=18,728). Out of this sample size, we identified 2,392 at-term newborns as positive for prenatal opioid exposure, and then we stratified them into 2 categories: birth weight ≤3.5kg (proxy for low or average birth weight with respect to gestational age thresholds) and birth weight ≥3.5kg (proxy for high birth weight with respect to gestational age thresholds). Thereafter, we ran SPSS statistical analyses involving chi square, t tests, and logistic regression to assess whether one birth weight group was more likely to have a higher incidence rate of NAS compared to the other birth weight group. Results: We found that even after controlling for significant confounders such as marital status, race, and pregnancy smoking, benzodiazepine, and marijuana use, infants who were in the low to average birth weight group (≤3.5kg in this study) were almost twice as likely (statistically significant adjusted odds ratio of 1.95) to develop NAS compared to infants who were in the high birth weight group (≥3.5kg in this study). Our study helps shed some important light on the discriminatory factors for NAS development, with birth weight being a significantly associated clinical factor as we now know. Discussion & Implications: Unfortunately, the mechanism for the transport of opioids across the placenta is complicated, and poorly understood. There may be more ‘unbound or free opioids’ available in infants of low to average birth weight (with respect to gestational age thresholds) compared to infants of high birth weight (with respect to gestational age thresholds) resulting in a higher incidence of NAS in the former population. It is more of a speculation rather than a conclusion to explain the results of our study. However, being equipped with this knowledge that opioid exposed neonates of low to average birth weight (with respect to gestational age thresholds) have a higher risk of developing NAS will allow physicians to identify infants with a higher risk for NAS early, and this will subsequently lead to better outcomes and reduced severity in cases of NAS.

Background: The incidence of neonatal opioid withdrawal syndrome (NOWS), a drug withdrawal syndrome mainly associated with opioid exposure in-utero has significantly increased in the United States over the last decade with infants with NOWS staying longer in the hospital than those without NOWS. Objectives: To determine if feeding tube use while on admission is associated with length of hospital stay among infants diagnosed with NOWS. We also compared the differences between infants with NOWS who required the use of feeding tubes while on admission, and those that did not, based on infant and maternal characteristics. Methods: This was a retrospective cohort study of infants delivered between July 1, 2011 and June 30, 2016 at Ballad Health System. Our inclusion criteria were infants who were exposed to opioids in-utero and received a diagnosis of NOWS based on 2 consecutive Finnegan scores of 10, or 3 consecutive scores of 8, or treatment with morphine. Medical chart record of 294 infants who met these criteria were reviewed for infant and maternal characteristics. Our outcome variable was infant length of hospital stay and our predictor variable was feeding tube use an indicator for feeding difficulties. Chi-square test and t-test were used to compare infant and maternal characteristics by feeding tube use. Simple linear regression models were used to assess the effect of feeding tube use and infant and maternal characteristics on infant length of hospital stay. Multiple linear regression was used to model infant length of hospital stay predicted by feeding tube use, while adjusting for neonatal intensive care unit (NICU) admission, treatment with morphine, and maternal benzodiazepine use during pregnancy. All analyses were done using SAS 9.4. Results: Of the 294 infants diagnosed with NOWS, 22.11% had feeding difficulties that necessitated use of feeding tubes. Infants who used feeding tubes were significantly more likely to be born preterm (20.31% vs 8.73%, p=0.0096) to be admitted into the NICU (98.46% vs 51.09%, p=