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Response to racial association and pharmacotherapy in neonatal opioid withdrawal syndrome: thinking beyond genetics

Journal of Perinatology volume 40, pages 691–692 (2020)Cite this article

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We would like to extend our thanks to Drs Grossman, Berkwitt, and Osborn for their thoughtful letter in response to our retrospective paper on pharmacotherapy in neonatal opioid withdrawal syndrome (NOWS) [1]. Their points on unconscious bias and its potential influence on the care of affected infants are well placed and well taken. NOWS is a highly variable disease that has a large impact on the healthcare system. Currently, it is impossible to accurately predict which infants will require pharmacotherapy since objective clinical factors such as maternal opiate dosage do not predict NOWS severity. Genetic factors likely account for a portion of the variability in presentation [2], and recent genome wide association studies have identified single-nucleotide polymorphisms (SNPs) associated with response to opiate therapy in both adult and pediatric populations. The strength of association between certain SNPs and higher opioid doses has been found to be different between self-reported African-American and European-American subjects [3, 4]. The authors did discuss the risk of prescriber bias in opioid dispensed, and emphasize the importance of larger studies to fully evaluate the allele variations across multiple ancestry groups.

The effect of unconscious bias on infants’ care has not been as thoroughly studied in the neonatology literature, and this is an important subject of future research in our field. We hope these letters to the editor result in increased awareness and research on the topic of unconscious bias in our population. Currently, the Modified Finnegan Neonatal Abstinence Scoring System is the predominant tool used in the United States for quantifying the severity of neonatal withdrawal signs. However, the subjective elements could lead to a risk of unconscious bias. We share the authors’ concerns, and we plan to continue our research in this field with the aim of creating more objective tools including genomic and other “omic” biomarkers to identify individualized risk prediction and to develop therapeutic strategies in neonates who are opioid exposed.

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References

  1. Parikh A, Gopalakrishnan M, Azeem A, Booth A, El-Metwally D. Racial association and pharmacotherapy in neonatal opioid withdrawal syndrome. J Perinatol. 2019;39:1–7.

    Article  Google Scholar 

  2. Wachman EM, Farrer LA. The genetics and epigenetics of neonatal abstinence syndrome. Semin Fetal Neonatal Med. 2019;24:105–10. https://doi.org/10.1016/j.siny.2019.01.002.

    Article  PubMed  Google Scholar 

  3. Gelernter J, Kranzler HR, Sherva R, Koesterer R, Almasy L, Zhao H, et al. Genome-wide association study of opioid dependence: multiple associations mapped to calcium and potassium pathways. Biol Psychiatry. 2014;76:66–74. https://doi.org/10.1016/j.biopsych.2013.08.034.

    Article  CAS  PubMed  Google Scholar 

  4. Smith AH, Jensen KP, Li J, Nunez Y, Farrer LA, Hakonarson H, et al. Genome-wide association study of therapeutic opioid dosing identifies a novel locus upstream of OPRM1. Mol Psychiatry 2017;22:346–52. https://doi.org/10.1038/mp.2016.257.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Jacob France Institute. Baltimore City Public School System, Analysis: Baltimore neighborhood indicators alliance. Baltimore, Maryland: The Jacob France Institute; 2017.

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Authors and Affiliations

  1. Department of Pediatrics, University of Maryland School of Medicine, 10 South Paca Street, 8th Floor, Baltimore, MD, 21201, USA

    Abhinav G. Parikh & Dina El-Metwally

  2. New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY, 11215, USA

    Abhinav G. Parikh

  3. Center for Translational Medicine, University of Maryland School of Pharmacy, 20, North Pine St, PH N517, Baltimore, MD, 21201, USA

    Mathangi Gopalakrishnan

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  1. Abhinav G. Parikh
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Correspondence to Abhinav G. Parikh.

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Parikh, A.G., Gopalakrishnan, M. & El-Metwally, D. Response to racial association and pharmacotherapy in neonatal opioid withdrawal syndrome: thinking beyond genetics. J Perinatol 40, 691–692 (2020). https://doi.org/10.1038/s41372-020-0618-0

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