WHAT’S THE ISSUE: More babies, both in the metro area and across the country, are being born with an opioid addiction because of their mothers’ use.
WHY DOES IT MATTER: Opioid abuse has risen across the country, and diagnosing and treating addicted babies isn’t always easy.
Opioid addiction is growing in the United States and reports have included pictures of those who fatally overdosed on prescription medications, illicit drugs or a combination of those.
A lesser-known image is the newborn baby who is extremely irritable, crying inconsolably and having feeding issues because the child is going through withdrawal.
They literally inherit the drug problem – babies born with an addiction to opioids because of their mothers' use, whether of prescription drugs or illegal drugs.
Doctors call it neonatal abstinence syndrome, or NAS, as being born technically is forced sudden withdrawal. Narcotics such as heroin, morphine and oxycodone are the most common drugs involved, but stimulants such as methamphetamine and cocaine and, sedatives and antidepressants also can cause problems.
Dena Hubbard of Sunflower Neonatology Associates, who is medical director of the NICU at Centerpoint Medical Center, said she's noticed more cases of NAS in recent years, particularly in Kansas at the Overland Park Regional Medical Center, but now a few cases in Eastern Jackson County at Centerpoint.
Doctors have officially recognized the syndrome for more than 40 years, but in the past decade or more there's been a spike. A New England Journal of Medicine report notes more than 21,700 infants in the United States in 2012 were diagnosed with NAS, a five-fold increase from the previous dozen years. Many recent studies indicate at least one baby born every hour now in the U.S. with NAS.
Martha Gershun, executive director for Court Appointed Special Advocates for children in Jackson County, said her workers have long dealt with cases of children affected by adult drug abuse, but only recently have they started seeing children born with a drug dependency. If the mother is an illegal drug addict, there's a chance that child ends up in the foster care system.
Gershun worries that it's just the tip of the iceberg for an already stressed institution, and like Hubbard she believes NAS children can be at risk of developmental delays.
“Already in Missouri, the foster system is terribly overburdened,” Gershun said. “It's a new cause of children entering the welfare system.”
How NAS happens
Hubbard can rattle off numerous symptoms of a baby that has NAS – rigid muscle tone, irritability, poor sleep, diarrhea, vomiting, poor feeding, excessive sneezing or yawning and the most common one being fast breathing. The potential issue, if the mother's medical history isn't known because she might fear consequences for disclosing her drug use, is that many NAS symptoms only become more apparent a few days after birth and many babies and new moms are heading home within 48 hours.
A hospital needs consent to test a mother but not the baby, and Hubbard said the American Pediatric Association now recommends that high-risk mothers automatically warrant a five-day admission for the baby.
Gershun said she believes that opioid usage has increased not just from pain medications morphing into abuse, but also from mental illness.
“They have a mental health issue, but don't have access to treatment, and they turn to street drugs to self-medicate,” she said.
Many times, Hubbard said, NAS comes from a mother simply taking a pain medication and unfortunately not knowing any better – perhaps not equating it to alcohol consumption during pregnancy. She said her big concern with NAS infants is their high risk for mistreatment at home, as a highly irritable baby and a new mother possibly on edge can be a troublesome combination.
“I've been seen it with nurses in a 12-hour shift,” Hubbard said, referring to the exhaustion at times of dealing with such babies in the NICU. “That can test anyone's patience.”
How to combat it
Hubbard says if they can learn a pregnant woman has an opioid addiction, methadone is a preferred drug because it has led to fewer instances of NAS and decreases withdrawal symptoms and the desire for illicit drugs. In addition, a new mother on methadone can still breastfeed. Abruptly stopping opioid use can cause a pregnant woman to have preterm labor or cause fetal distress and even death.
For babies born with NAS, they try non-pharmacological care first – gentle handling and minimal stimulation but plenty of swaddling, holding, cuddling and manual rocking, additional feeding if needed and active maternal participation and rooming-in if possible and appropriate.
If that doesn't work or symptoms worsen, then morphine or methadone can be used and the baby later weaned off it.
“The majority we've taken care of have gone home with the parents,” Hubbard said.
Hubbard said the medical community has started to realize its partial complicity in opioid abuse due to over-prescriptions, so pain management in ways other than prescription narcotics should be encouraged.
“Medications are not figuring out the underlying problem,” she said.
Having non-punitive rehabilitation programs for pregnant women, a rehabilitation program for mothers and babies together after leaving the hospital and recognizing and treating mental illness better all can go a long way to battling NAS, Hubbard said.
“Having mother and baby together, in most cases, is beneficial,” she said.
Missouri is the only state without a statewide prescription drug monitoring program. While local jurisdictions have worked to establish one and a bill for a statewide program is making its way through the Missouri General Assembly, Gershun says that wouldn't necessary fix the problem of pregnant women using illegal drugs.
She also believes mental illness treatment is a key to combating NAS and would like to see Medicaid expanded to cover mental health services for the poor.
“It's a lot cheaper up front than treating an addict (later),” she said, adding that taxpayer dollars already go toward the problem through jails and the foster care system. “Looking at it with the purely best intention, for those unable to participate and pay taxes, it's cheaper to spend the money up front.
“There's just very limited access,” she said of mental health care for the poor, with barriers like child care, transportation and time off work. “It's a very complicated issue along with poverty.”
Hubbard agrees that neonatal abstinence syndrome is a complex problem – one that could well get worse and eventually cycle through another generation if not effectively addressed. Besides the medical community, courts and social services, potential developmental issues lead to schools having a stake.
“We are in a crisis,” she said. “There are multiple systems involved.”