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Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis

Research output: Contribution to journalArticle

Philippa Rees, Philippa Anna Stilwell, Chrissy Bolton, Merve Akillioglu, Ben Carter, Christopher Gale, Alastair Sutcliffe

Original languageEnglish
JournalJournal of Pediatrics
Accepted/In press3 Jun 2020

King's Authors


Objective: To systematically review and meta-analyse the association between NAS and adverse health or educational childhood outcomes.
Study Design: An all-language search was conducted across 11 databases between January 1, 1975, and September 3, 2019, and 5865 titles were identified. Observational studies of children between 28 days and 16 years of age, in whom a diagnosis of NAS was documented, were included. Outcomes included reasons for hospital admissions, childhood diagnoses, developmental outcomes, and academic attainment scores. All studies underwent independent review by two trained reviewers, who extracted study data and assessed risk of bias using the Newcastle Ottawa Tool.

Results: Fifteen studies were included: comprising 10,907 children with previous NAS and 1,730,213 children without previous NAS, aged 0-16 years. There was a strong association between NAS and: subsequent child maltreatment (aOR 6.49 (4.46, 9.45, I2=52%)), injuries and poisoning (aOR 1.34 (1.21, 1.49, I2= 0%)), and a variety of mental health conditions. Studies consistently demonstrated increased incidence of strabismus and nystagmus amongst those with previous NAS. Children with NAS also had lower mean academic scores than controls in every domain of testing across age groups.

Conclusions: NAS is significantly associated with future child maltreatment, mental health diagnoses, visual problems and poor school performance. Due to the necessary inclusion of non-randomized studies, incomplete reporting amongst studies and likely unadjusted confounding, this review does not suggest causation. However, we highlight important associations requiring urgent further investigation and targeted intervention, to positively impact the life course trajectories of this growing cohort of children.

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