Neonatal abstinence syndrome (NAS) is diagnosed in infants with withdrawal symptoms after fetal exposure to addictive substances.1 Opioids and amphetamines are the most common drugs that cause NAS, but other substances, such as alcohol, benzodiazepines, or some antidepressants, can also be the cause.2 Previously, it has not been well-established whether a diagnosis of NAS at birth affects the likelihood of the child developing autism or developmental disorder in childhood.3 We matched 12,303 infants born in 2017 or 2018 who were diagnosed with NAS to 24,606 infants who were born in the same year, shared the same social determinants of health, and had the same number of visits to their healthcare provider, but were not diagnosed with NAS, using a 1:2 ratio. We compared these groups to identify how NAS might affect a child’s likelihood of developing autism or speech or motor developmental disorders as the child approaches 5 years of age.
Of children born in 2017 and 2018, the NAS-diagnosed infants were 27% more likely to have developed speech developmental disorders, 68% more likely to have developed motor developmental disorders, and 26% more likely to have developed autism (Figure 1).
Diagnosing autism can be difficult in young children, and many are not diagnosed until they are older than five years of age.4 To determine whether infants born with NAS continued to develop autism at greater rates than the general population as they get older, we separately evaluated the prevalence of autism in the general population from birth until age nine and compared it to the prevalence of autism in those in the same age range who were diagnosed with NAS. While the prevalence of autism increased as both populations got older, those diagnosed with NAS continued to see an 80% increase compared to the general population.
These results reinforce the importance of educating patients and their families on prenatal exposures to substances that can lead to NAS. Pregnant patients should discuss potential treatment options with their provider, as discontinuing use of these substances too quickly during pregnancy can also be harmful to their unborn child.2
Additionally, these results highlight the need for frequent and timely screenings for autism, speech developmental disorders, and motor developmental disorders for infants diagnosed with NAS at birth. Staying on schedule with well-child checks for infants diagnosed with NAS can facilitate early intervention and therapy to minimize developmental impacts and improve outcomes for these children.4
*Our observed rates of the three disorders for non-NAS diagnosed children in our study population are higher than those published in previous studies.5 This is likely due to our matching algorithm that required a certain number of healthcare encounters and other socioeconomic characteristics to minimize other differences between the NAS and non-NAS study groups.
