Longitudinal Outcomes of Children Exposed to Opioids In-utero: A Systematic Review

Purpose: The purpose was to summarize evidence of long-term outcomes of children, 2 years and older, exposed to opioids in-utero. Design: This was a systematic review. Studies were identified by searching the following electronic databases: PubMed, EBSCO HOST/Medline, and Web of Science. Articles were published between 1979 and 2019. Methods: This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis. Two sets of two independent reviewers extracted data and assessed study quality according to National Institutes of Health quality assessment tools. Results: Forty-three articles met inclusion criteria. Synthesis of articles identified trends toward worse outcomes for children with in-utero opioid exposure in all areas, most notably related to academic success, behavior, cognition, hospitalizations, and vision. Conclusions: Findings reinforce the necessity of continued research in this area with improved study design. Despite limitations in the current body of evidence, findings from this review are vital knowledge for clinicians, because children exposed to opioids in-utero are clearly vulnerable to a wide variety of suboptimal health and developmental outcomes. Clinical Relevance: Recognition of all outcomes across childhood associated with in-utero opioid exposure will inform improved identification and interventions tailored to the most pressing needs of affected children. Despite the need for continued research, there is sufficient evidence to necessitate close, individualized follow-up throughout childhood.