Dilek Kahvecioglu, Melda Tas Gungor, Sumru Kavurt, Ismail Bulut, Aslihan Abbasoglu, Deniz Akca, Selvi Gulası, Huseyin Cagri Bulut, Ramazan Kececi, Aytac Kenar, Elvis Kraja, Husnu Fahri Ovalı, Dilek Damla Saymazlar, Avidan Kızılelma, Ercan Tutak, Nilufer Matur Okur, Duygu Tuncel, Huseyin Simsek, Mustafa Akcalı, Bengu Karacaglar, Seyma Butun Turk, Kiymet Celik, Hakan Ongun, Fatma Çakmak Çelik, Fatma Kaya Narter, Ece Koyuncu, Yucel Pekal, Ipek Guney Varal, Onur Bagcı, Hulya Selva Bilgen, Nazife Reyyan Gok, Gokhan Buyukkale, Seda Yılmaz Semerci, Ali Bulbul, Yusuf Iskender Coskun, Murat Konak, Saime Sundus Uygun, Ersin Ulu, Cem Geyık, Ozgul Tunc Akbas, Betul Acunas, Merih Cetınkaya, Hakan Aylanc, Alaattin Kızıl, Nihan Tufan, Arife Canpolat, Ayla Gunlemez, Halime Sema Can Buker, Nuriye Tarakcı, Dilek Sarıcı, Esin Koc
This prospective multicenter cohort from Türkiye demonstrated a stimulant-predominant exposure pattern distinct from opioid-dominant cohorts. Clinical severity, rather than exposure group, independently predicted pharmacological treatment, while abandoned infant status was the strongest determinant of prolonged hospitalization. National pathways should address diagnostic heterogeneity, treatment resources, and social-care barriers.
BACKGROUND: Evidence on neonatal manifestations following prenatal substance exposure outside opioid-dominant settings is limited, and Türkiye lacks national multicenter data on exposure patterns and neonatal care.
OBJECTIVE: To characterize opioid and non-opioid prenatal substance exposures, neonatal manifestations, management, short-term outcomes, and factors associated with pharmacological treatment and prolonged hospitalization in Türkiye.
METHODS: This prospective observational study enrolled infants aged 0-28 days who were clinically diagnosed with NAS following documented prenatal opioid or non-opioid substance exposure at 32 neonatal intensive care units between September 2, 2024, and September 2, 2025. Exposure classification relied predominantly on self-report, with limited toxicological confirmation. Multivariable logistic regression evaluated factors associated with pharmacological treatment and hospitalization lasting >18 days.
RESULTS: Among 137 infants from 17 provinces, stimulant-only exposure was the most common single-group pattern (51/137, 37.2%), and methamphetamine was the most frequently identified substance (57/137, 41.6%). Pharmacological treatment was given to 50 infants (36.5%), most commonly phenobarbital; morphine-containing regimens were used in four. Maximum Finnegan score independently predicted pharmacological treatment (adjusted OR 1.53 per point, 95% CI 1.30-1.80). Prolonged hospitalization was associated with maximum Finnegan score, gestational age, 1-minute Apgar score, and abandoned-infant status, with the latter showing the strongest association (adjusted OR 6.00, 95% CI 2.38-15.10).
CONCLUSION: This prospective multicenter cohort from Türkiye demonstrated a stimulant-predominant exposure pattern distinct from opioid-dominant cohorts. Clinical severity, rather than exposure group, independently predicted pharmacological treatment, while abandoned infant status was the strongest determinant of prolonged hospitalization. National pathways should address diagnostic heterogeneity, treatment resources, and social-care barriers.