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In Utero Xylazine Exposure Associated with Feeding Difficulties in Infants with Neonatal Opioid Exposure
Kelsey, Stefanie Geiger Litzky, Julia Pahl, Adrienne Young, Leslie Comeau, Mary-Kara Buonanno, Olivia
Kelsey, Stefanie Geiger
Litzky, Julia
Pahl, Adrienne
Young, Leslie
Comeau, Mary-Kara
Buonanno, Olivia
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Abstract
Background Xylazine, a non-opioid alpha-2-adrenergic veterinary tranquilizer, has become a significant adulterant in the US illicit drug supply. In Vermont, xylazine is nearly ubiquitous in fentanyl and heroin. Data from veterinary medicine implies potentially serious implications for fetal growth and development but currently little is known about the effects of xylazine in human fetuses and infants. Objective To describe symptomology associated with xylazine exposure and withdrawal in infants with gestational opioid exposure. Design/Methods This is a retrospective chart review of infants born >35 weeks and monitored for neonatal opioid exposure between August 2022-October 2024 at the University of Vermont Children’s Hospital. Xylazine exposure was identified by drug testing or parental report. Data related to growth, withdrawal symptoms and feeding patterns were collected. Results Xylazine-exposed infants more consistently had difficulty feeding than those without known exposure, and those treated with methadone and clonidine did not show improvement in feeding symptoms following treatment. Infants who required NG feeds took an average of 12 days to reach full ad lib oral feeds (range 6-22 days). One infant did not require gavage feeding but later required g-tube placement due to poor oral intake. One infant had only early pregnancy exposure and no feeding difficulty. Exposed infants were noted by SLP to have oral greater than pharyngeal stage difficulties characterized by reduced latch, ineffective nutritive suck pattern and difficulty with suck-swallow-breathe organization. All exposed infants required increased caregiver support and compensatory strategies to promote developmentally appropriate oral feeds, reduce risk of feeding-induced cardiorespiratory events, and improve feeding quality. Discussion With virtually no data regarding xylazine use in pregnancy in humans and replicable data demonstrating serious implications to fetal growth of xylazine exposure in animal pregnancies, there is a need for more research to determine the impact of this growing public health concern to neonates. More robust data of the effects of xylazine on the developing fetus and its withdrawal on infants may guide prenatal and neonatal care as well as public health approaches and community harm reduction strategies.
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Date
2025-01-01