Diagnostic accuracy and reliability of portable visual field-testing devices for detecting manifest glaucomatous visual-field loss: a systematic review and meta-analysis.

Opioid use has increased dramatically and presents a major public health concern in North America []. The majority of women misusing opioids are within childbearing age []. In Manitoba, administrative health data identified opioid prescriptions in 7.7% of pregnancies in 2013 []. The outcomes of neonates following prescription prenatal opioid exposure (PPOE) are well-recognized in the literature and include increased risk for prematurity, low birth weight and neonatal opioid withdrawal syndrome (NOWS) []. However, a recent systematic review has identified gaps in evidence evaluating the long-term neurodevelopmental outcomes following PPOE []. These include inadequate control over confounding factors such as environmental, social and genetic variables that can impact the long-term neurodevelopmental outcomes of PPOE, small sample sizes, heterogeneity among included studies emerging from variations in type of opioid exposure, study populations, and assessment tools hindering meta-analysis. Few studies have provided inconsistent insights into the potential neurodevelopmental effects of PPOE. Studies yielded conflicting results regarding Bayley Scales of Infant and Toddler Development scores [–]. Developmental vulnerability scores are important indicators of children’s neurodevelopment and can signal areas for intervention with the potential to improve long-term outcomes []. A few recent studies evaluated the educational outcomes among children with NOWS and reported that neonatal withdrawal was strongly associated with poor and deteriorating school performance, and significantly increased the likelihood of developing a subsequent educational disability [, ]. Studies conducted in the United States and Australia assessed educational outcomes in children with NOWS; however, because not all infants with PPOE meet the diagnostic criteria for NOWS, the expected outcomes following PPOE are not well understood. We hypothesize that children with PPOE are at a higher risk of having developmental vulnerability than children unexposed to prescription opioids during pregnancy. To answer this question, we conducted a retrospective matched cohort study to investigate the association between PPOE and neurodevelopmental outcomes at 6 years of age. Furthermore, we evaluated the effect of PPOE on developmental outcomes among siblings where one or more of the siblings were exposed and one or more were unexposed within the same family. By conducting a sibling analysis, we aimed to mitigate the influence of unmeasured confounding factors stemming from the complex interplay of biological, social, and environmental elements affecting children exposed to opioids in utero.