ABSTRACT
Neonatal Opioid Withdrawal Syndrome (NOWS) is a major public health problem in the USA. Since 2000-
2012, the incidence of NOWS has increased five-fold to almost 6 per 1,000 hospital births and the associated
health care expenditures have increased from $200 million to $1.5 billion. Limited data are available on the
effects of antenatal opioid exposure on the brain and neurodevelopment because of small sample
sizes and difficulty controlling for important environmental variables. The OBOE (Outcomes of Babies
with Opioid Exposure) study, an ongoing NICHD-funded longitudinal study enrolling infants with and
without antenatal opioid exposure at birth and following them to two years of age, attempts to address
these limitations by collecting comprehensive exposure data from parental report and from infant
umbilical cord analysis; advanced neuroimaging data to evaluate brain development; standardized
information on the home environment, maternal mental health, and parenting; and neuro-
developmental outcomes to 2 years of age. The OBOE consortium, comprised of 4 highly performing
clinical centers, a data coordinating center, and a neuroimaging core, has completed our goal
enrollment of 200 opioid-exposed infants and 100 unexposed infants. In response to RFA-HD-24-014,
we now propose to complete follow-up to age two years in our OBOE cohort to fulfill our main study
objectives. The CHOP/PENN site has enrolled 46 infants (34 exposed and 12 controls), completing
53 MRIs across 2 timepoints thus far, contributing to the publication of multiple abstracts and three
manuscripts using OBOE data, and developing the CONSENTER intervention to improve recruitment
of exposed and control patients. For this renewal grant, we will continue progress toward our aims to:
1) determine the impact of antenatal opioid exposure on brain structure and connectivity over the first
two years of life; 2) define medical, developmental, and behavioral trajectories over the first two years
of life in exposed infants; and 3) determine how the home environment, maternal mental health, and
parenting modify trajectories of brain connectivity and neurodevelopment over the first two years of
life. Our progress so far, with enrollment completed and success in following this difficult population,
shows that we can successfully complete the objectives of the OBOE study.