Infants Born with NAS Show Higher Rates of Torticollis

Published May 1, 2018 | The Journal of Pediatrics

Infants born with neonatal abstinence syndrome (NAS) due to opioid exposure in utero show a significant increase in torticollis—an abnormal twisting of the neck. Many also have plagiocephaly—a flattening of the head often seen in conjunction with torticollis.

The study, led by Jenny McAllister, MD, Eric Hall, PhD, and Scott Wexelblatt, MD, ranks among the few so far to explore the longer-term effects of maternal opioid exposure. Cincinnati Children’s offers one of the few clinics in the nation that treat and follow these infants as they grow.

“Awareness of these potential issues in this population is essential as torticollis may not develop for several months after the infant has been discharged,” McAllister says. “If preventive measures are performed, such as occupational and physical therapy, torticollis and plagiocephaly may be avoided and potentially prevent developmental delays.”

The opioid epidemic has greatly affected the Cincinnati area. From 2012 to 2016, 29.4 per 1,000 live births had in utero opioid exposure. Of these, 35.1 percent, or 10.3 per 1,000 live births, were diagnosed with NAS.

McAllister and colleagues studied 783 infants who were treated for NAS. Of those, 87 experienced torticollis, an incidence rate of 11.1 percent—more than three times normal incidence. More than 72 percent of these infants had been exposed to multiple opioids.

Whether exposure in utero directly causes torticollis remains unclear. Infants often have hypertonia, a tightness of muscles, as a symptom of withdrawal, which can lead to torticollis. The incidence rate also might reflect how infants were positioned and swaddled to keep them calm.

“This type of torticollis does not appear to involve fibrotic change in the muscle and can be easily treated if caught early,” the co-authors wrote. “However, if left untreated, true neck contracture may develop along with craniofacial abnormalities.”