(476) Prenatal fentanyl exposure and replication of a novel neonatal syndrome study at a single institution

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Elizabeth L. Mirsky, MD (she/her/hers)

Maternal Fetal Medicine Fellow
University of Kentucky
Lexington, Kentucky, United States

Coauthor(s)

CC

Cynthia Cockerham, N/A

Community Program & Research Director
University of Kentucky
Lexington, Kentucky, United States
WW

Wendy Whitley, RN

University of Kentucky
Lexington, Kentucky, United States
GH

Gregory Hawk, PhD

Postdoctoral scholar
University of Kentucky
Lexington, Kentucky, United States
AS

Asmita Shrestha, MPH

University of Kentucky
Lexington, Kentucky, United States
JO

John O'Brien, MD

Professor of Maternal Fetal Medicine, Medical Director of Maternal Maternal Fetal Medicine
University of Kentucky
Lexington, Kentucky, United States
Barbara V. Parilla, MD

Professor of Obstetrics and Gynecology
University of Kentucky
Lexington, Kentucky, United States

Objective: To determine if findings from a previous study on a novel neonatal syndrome associated with prenatal fentanyl exposure (Wadman et al, 2023) can be identified at our institution.

Study Design: Potential cases of this novel syndrome were identified from a prospectively collected database of obstetric patients with substance use disorder (SUD) enrolled in a multispecialty treatment program from 2014 to 2024. The database was screened for neonatal findings consistent with this novel syndrome in cases with prenatal fentanyl exposure resembling Smith-Lemli-Opitz (SLO) syndrome including microcephaly, cleft palate, clubfoot, rocker bottom feet, toe syndactyly, single palmar crease, hypoplastic corpus callosum, and hypospadias.

Results: 639 patients were enrolled in a perinatal substance use treatment program and study. Of the 103 patients found to have neonates with a small head size (head circumference < 10%), 34 individuals self-reported fentanyl use in the 30 days prior to enrollment in the program, with an additional 17 reporting use within the last year. Six of these individuals had confirmatory drug screening for fentanyl. Of the 6 cases with confirmed fentanyl use on drug screening, all patients screened positive in the first trimester. Four neonates displayed characteristic anomalies consistent with a SLO-like syndrome (Table 1). All cases shared lagging head growth, while additional anomalies identified included cleft palate, short nasal tip, thin upper lip, micrognathia, and hypospadias. Of the cases with anomalies, all individuals had polysubstance use. Genetic screening/diagnostic testing varied but an assessment of cholesterol metabolism was not performed.

Conclusion: This study suggests the potential association of prenatal fentanyl exposure with a novel syndrome. As the opiate crisis continues, fueled by rising fentanyl use, more data is needed to confirm and delineate this association and determine the possible long-term developmental effects of such a syndrome.