Recovery Following Palate Repair Among Infants With Neonatal Abstinence Syndrome

Introduction: Neonatal abstinence syndrome (NAS), a withdrawal syndrome that can occur from in-utero exposure to certain substances (most commonly opioids), has been linked to many congenital malformations including orofacial clefts. It is unclear if infants with NAS have higher analgesic requirements following surgery such as cleft palate repair.

Methods: A retrospective cohort study was conducted at a single tertiary medical center. The charts of children who underwent cleft palate surgery between 2011-2021 were examined. In-utero exposure to cocaine and/or illicit or prescription opioids was used as inclusion criteria for the NAS patient group. Age-matched control subjects undergoing identical surgeries during the study period were also assessed. An independent two-sample t-test was used to compare mean clinical outcomes.

Results: 47 distinct patient surgical encounters were reviewed, 37 control patients were compared to 10 patients with a history of NAS. Both populations demonstrated additional comorbidities and had similar medical complexity. No significant differences were found between study groups. Immediate postoperative outcomes examined included postoperative length of stay which was 40.2hrs for NAS patients versus 40.3hrs for control patients (p=0.99); duration of IV fluid supplementation was 28.9hrs versus 27.6hrs (p=0.87); time until first oral intake was 12.1hrs versus 11.0hrs (p=0.84); total weight-based opioid analgesic doses was 2.9 doses versus 3.0 doses (p=0.93), and total weight-based non-opioid analgesic doses was 8.0 doses versus 7.7 doses (p=0.84).

Conclusions: Although this is a small preliminary study, our findings suggest that children with a history of NAS may experience similar immediate postoperative needs following repair of cleft palate.