Prenatal Fentanyl Abuse May Have Caused a New Syndrome in Babies

A new syndrome of birth defects, apparently caused by fentanyl abuse, has been identified at a Delaware hospital.

In mid-2022, doctors at Nemours Children's Hospital in Delaware noticed a worrying and unusual trend among newborn babies referred to their care. A group of babies, who arrived at different times and through separate referral routes, all shared unusual facial features and birth defects.

A new study, organized by senior author Karen W. Gripp, who is also chief of the division of medical genetics at Nemours, assessed six infants from the hospital and another four who were identified at other centers. The study was published in Genetics in Medicine Open.

The newborns, Gripp said, had a wide group of rare characteristics and malformations, including:

• Below-average height
• Small heads
• Cleft palate
• “Rocker bottom” feet, which bend upwards to touch the shins
• Fused toes
• Malformed genitalia

Ruling out gene conditions

The medical team’s first thought was that the babies had a rare genetic condition, like Smith-Lemli-Opitz syndrome. But testing ruled this out. A facial analysis system called GestaltMatcher was used to rule out fetal alcohol syndrome, a common cause of newborn physical malformations that occurs when a woman drinks large amounts of alcohol during pregnancy.

The team realized they might be dealing with a new condition altogether when they ascertained that all the children’s mothers had been using fentanyl while they were pregnant. Fentanyl, the ultra-strength synthetic opioid, can cross the placental barrier and cause birth defects. The team was only able to establish limited information about how much of the drug the babies’ mothers had used, meaning that it remains unclear whether the syndrome affecting the infants was due to fentanyl, a contaminant or influence from another drug.

Evidence of a wider problem

Gripp’s colleagues now report that other, anecdotal evidence suggests that the features identified in the study have been seen in other children born to fentanyl-using mothers, potentially on a spectrum of severity. Of the 10 children in the study, 6 were are still receiving care from the Nemours team, while 3 more are being followed by hospital systems in other states. One child has sadly passed away.

“Given the fentanyl use epidemic, it is important to recognize this condition,” Gripp said in a press release. “Analogous to prenatal alcohol exposure causing fetal alcohol syndrome with long-term physical and developmental consequences, this novel condition may impact many infants in life-changing ways.” The authors say that more work, including laboratory analysis, is needed to confirm the findings definitively.

Reference: Wadman E, Fernandes E, Muss C, et al. A novel syndrome associated with prenatal fentanyl exposure. Genetics in Medicine Open. 2023;1(1). doi:10.1016/j.gimo.2023.100834

This article is a rework of a press release issued by Nemours Children Health. Material has been edited for length and content.