Every Hour a Baby is Born Addicted to Opioids

Understanding Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) is a group of conditions that occur when a baby withdraws from certain drugs, primarily opioids, that they were exposed to in the womb before birth. The incidence of NAS has significantly increased in recent years, resulting in both immediate and long-term consequences for affected babies.

Definition and Causes

NAS occurs when a baby experiences withdrawal symptoms due to the discontinuation of opioids or other addictive substances after birth. The drugs that the baby was exposed to during pregnancy can include prescription opioids, such as oxycodone or hydrocodone, as well as illegal substances like heroin. These substances can pass through the placenta, exposing the developing baby to their effects.

The developing baby becomes dependent on these drugs, and after birth, when the supply is suddenly cut off, they experience withdrawal symptoms. The severity and duration of these symptoms can vary depending on several factors, including the type and amount of drugs used during pregnancy, the duration of exposure, and the baby's individual metabolism.

Incidence and Impact

The incidence of NAS has significantly increased in recent years, posing a growing concern for healthcare providers and society as a whole. According to a study published on NCBI Bookshelf, the incidence of NAS has increased fivefold in the past decade, with a diagnosis occurring approximately every 25 minutes in the United States.

The rise in NAS is closely linked to the increase in opioid use during pregnancy. The prevalence of opioid use among pregnant women in the United States has increased by 333% over a 15-year period, from 1999 to 2014. This increase has led to a corresponding rise in the incidence of NAS. Furthermore, the incidence of NAS among babies insured by Medicaid has dramatically increased by fivefold between 2004 and 2014.

NAS not only affects the immediate health of newborns but also has significant long-term implications. Babies with NAS may experience developmental problems, including issues with hearing, vision, learning, and behavior. They may also be at an increased risk of medical complications. The long-term impact of NAS necessitates ongoing monitoring and support to address the potential challenges faced by these children as they grow.

The incidence and impact of NAS highlight the importance of addressing opioid use during pregnancy and implementing effective strategies for prevention, intervention, and treatment. By understanding the causes and consequences of NAS, healthcare providers and society can work together to support affected infants and their families and strive towards a future where every baby has the opportunity for a healthy start in life.

Signs and Symptoms of NAS

Neonatal Abstinence Syndrome (NAS) can present with various signs and symptoms, which can vary in their timing and severity. It is important to recognize these indicators to ensure prompt intervention and appropriate care for affected newborns.

Variability and Timing

Signs of NAS can manifest differently in each baby, appearing within 3 days (72 hours) of birth and lasting from 1 week to 6 months after birth. The timing and severity of symptoms can depend on several factors, including the type and amount of substance exposure during pregnancy.

Common signs and symptoms of NAS may include:

• Excessive crying or irritability
• Poor feeding or sucking difficulties
• Tremors or shakes
• Sleep disturbances
• Hyperactive reflexes
• Excessive sneezing or yawning
• Sweating or fever
• Rapid breathing or respiratory distress
• Tight muscle tone or stiffness
• Digestive issues, such as vomiting or diarrhea

It is important to note that not all babies exposed to opioids during pregnancy will develop NAS, and the severity of symptoms can vary. Close monitoring and assessment by healthcare professionals are essential to identify and address any signs of withdrawal.

Medical Complications and Risks

Babies with NAS may require treatment in the neonatal intensive care unit (NICU) after birth due to the potential complications associated with their condition. These infants are at an increased risk of medical problems, including:

• Respiratory distress or difficulty breathing
• Low birth weight or growth restriction
• Premature birth
• Feeding difficulties or inadequate weight gain
• Seizures
• Jaundice (yellowing of the skin and eyes)
• Increased risk of infections

The duration and intensity of medical complications can vary, depending on the severity of NAS and the overall health of the baby. Prompt medical attention and appropriate treatment are crucial to ensure the well-being and recovery of these infants.

Understanding the signs and symptoms of NAS, along with the associated medical risks, allows healthcare professionals to provide timely interventions and support to newborns affected by opioid exposure during pregnancy. By addressing these challenges early on, the potential long-term effects of NAS can be minimized, and affected babies can receive the care they need to thrive.

Treatment of Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) requires prompt and specialized treatment to address the symptoms and complications associated with opioid withdrawal in newborns. The treatment primarily focuses on providing hospital care and utilizing medications and therapies to manage the condition effectively.

Hospital Care and NICU

Babies with NAS may require treatment in the neonatal intensive care unit (NICU) after birth, particularly if they exhibit severe withdrawal symptoms or have medical complications. The NICU provides a controlled environment where healthcare professionals can closely monitor and manage the baby's condition.

In the NICU, the healthcare team employs various strategies to provide essential care for infants with NAS. These include:

• Pharmacologic management: Medications like morphine and methadone are commonly used to help infants with NAS by weaning them off opioids. The dosing and weaning procedures may vary among hospitals, emphasizing the need for individualized care during medication administration.
• Environmental modifications: Creating a calm and soothing environment can help alleviate the symptoms of withdrawal. Reducing noise and providing swaddling or gentle rocking can help comfort the baby.
• Nutritional support: Infants with NAS may have difficulty feeding due to their withdrawal symptoms. Healthcare providers closely monitor their feeding patterns and may employ specialized techniques, such as smaller, more frequent feedings or utilizing nasogastric tubes if necessary.

Medications and Therapies

Medications play a crucial role in managing the symptoms of Neonatal Abstinence Syndrome. They are used to alleviate withdrawal symptoms and help infants gradually withdraw from opioids. Commonly used medications include morphine and methadone.

• Morphine: Morphine is an opioid agonist that helps alleviate withdrawal symptoms in infants. It is administered in controlled doses and gradually tapered to minimize withdrawal effects.
• Methadone: Methadone is another medication used to manage Neonatal Abstinence Syndrome. It works by stabilizing the baby's opioid receptors and reducing withdrawal symptoms. Similar to morphine, methadone is administered in controlled doses and gradually reduced.

While medication-based treatment is commonly utilized, there is ongoing research and clinical trials exploring non-pharmacologic approaches to managing NAS. The ACT NOW Eat, Sleep, Console (ESC) Clinical Trial, for example, focuses on involving parents in comforting the babies and assisting with their eating and sleeping routines. This non-medication approach shows promising results in providing care for infants with NAS [3].

It is important to note that the treatment of NAS requires a multidisciplinary approach involving healthcare professionals, including neonatologists, nurses, and social workers. The treatment plan is tailored to meet the individual needs of each baby, aiming to minimize withdrawal symptoms and ensure their overall well-being.

Long-Term Effects and Challenges

Neonatal Abstinence Syndrome (NAS) can have long-term effects on infants, leading to developmental problems that require ongoing monitoring and support. It is important to recognize and address these challenges to ensure the best possible outcomes for babies born with NAS.

Developmental Problems

Babies with NAS may face various developmental problems as a result of their exposure to opioids in the womb. These problems can include hearing and vision issues, learning difficulties, and behavioral problems. The severity of these problems can vary depending on the individual and the specific circumstances of their exposure.

Long-term developmental problems may require early intervention services, such as speech therapy, occupational therapy, or special education programs. It is important for healthcare providers and caregivers to closely monitor the child's development to identify any potential delays or challenges that may require intervention.

Ongoing Monitoring and Support

Babies born with NAS often require close monitoring and support throughout their early years. Medical professionals will continue to assess their growth, development, and overall well-being. This monitoring helps to identify any potential issues or delays that may arise as the child grows.

Supportive care and interventions can play a crucial role in helping babies with NAS thrive. Calming techniques like skin-to-skin care, swaddling, and gentle handling can be beneficial during the treatment process. Additionally, early intervention services can provide specialized support and therapies to address developmental challenges and promote optimal growth and development.

Parents and caregivers should work closely with healthcare providers, therapists, and support groups to ensure the child's ongoing needs are met. This collaborative approach helps to establish a comprehensive support system that addresses the unique challenges associated with NAS.

By addressing the long-term effects and challenges of NAS, healthcare providers and caregivers can provide the necessary support and interventions to optimize the developmental outcomes for babies born with this condition. Ongoing monitoring and early intervention services are key components in helping these children reach their full potential and lead healthy, fulfilling lives.

Addressing Opioid Use in Pregnancy

The prevalence of opioid use during pregnancy has seen a significant increase in recent years, reflecting the opioid epidemic observed in the general population. This escalation in opioid use has had profound consequences, including an alarming rise in the number of babies born addicted to opioids. In fact, every hour a baby is born addicted to opioids, resulting in a condition known as Neonatal Abstinence Syndrome (NAS) [2].

Prevalence and Risks

According to the Centers for Disease Control and Prevention (CDC), the number of women with opioid-related diagnoses during delivery increased by 131% from 2010 to 2017. In 2019, self-reported data indicated that approximately 7% of women reported using prescription opioid pain relievers during pregnancy, with 1 in 5 of those women reporting misuse. These statistics highlight the pervasive nature of opioid use among pregnant women [4].

The risks associated with opioid use during pregnancy are significant. Opioids can cross the placenta, exposing the developing fetus to these powerful drugs. This exposure can lead to various complications, including preterm birth, low birth weight, stillbirth, and an increased risk of birth defects. Additionally, infants born to mothers who used opioids during pregnancy are at a higher risk of developing NAS.

Screening and Intervention

Addressing opioid use in pregnancy requires a comprehensive and multi-faceted approach. It begins with early identification and screening of pregnant individuals who may be at risk for opioid use or misuse. Healthcare providers play a crucial role in identifying and addressing opioid use by implementing routine screening protocols and ensuring non-judgmental and supportive communication with patients.

Screening for opioid use can be conducted using validated screening tools and urine drug testing. These assessments help healthcare providers identify individuals who may require further intervention, such as referral to specialized addiction treatment programs.

Interventions for pregnant individuals struggling with opioid use often involve a combination of medication-assisted treatment (MAT) and psychosocial support. MAT involves the use of medications, such as methadone or buprenorphine, to manage withdrawal symptoms and reduce cravings. These medications are carefully prescribed and monitored by healthcare professionals experienced in treating pregnant individuals with opioid use disorder.

Psychosocial support, including counseling, therapy, and support groups, is an essential component of comprehensive care for pregnant individuals with opioid use disorder. These interventions address the physical, emotional, and social factors that contribute to opioid use and provide strategies for recovery and relapse prevention.

By implementing effective screening protocols and providing timely interventions, healthcare providers can play a vital role in addressing opioid use in pregnancy and reducing the incidence of NAS. Collaborative efforts between healthcare professionals, addiction specialists, and community resources are crucial in providing comprehensive care and support to pregnant individuals affected by opioid use.

Advancements in NAS Care

As the understanding of Neonatal Abstinence Syndrome (NAS) continues to grow, researchers and healthcare providers are making significant advancements in the care and treatment of babies affected by opioid exposure. This section will explore some of the research studies, clinical trials, innovative approaches, and best practices that are shaping the field of NAS care.

Research Studies and Clinical Trials

The ACT NOW research program, supported by the NIH HEAL Initiative, is conducting studies across the country to assess, treat, and follow up with babies diagnosed with NAS. One study focuses on weaning infants from medication doses, aiming to enhance their outcomes and reduce healthcare costs. The goal is to provide the best care possible for these infants.

Another significant clinical trial within the ACT NOW program is the Eat, Sleep, Console (ESC) Clinical Trial. This trial is testing a non-medication treatment approach for NAS, involving parents in comforting babies and helping them eat and sleep. By simplifying the assessment of infants with NAS and focusing on non-pharmacologic therapies, this approach has shown promising results in providing care for these infants.

These research studies and clinical trials are instrumental in expanding our understanding of NAS and refining treatment approaches for affected infants. They contribute to the development of evidence-based interventions that can improve outcomes and reduce the reliance on medication.

Innovative Approaches and Best Practices

In addition to research studies and clinical trials, healthcare providers have been implementing innovative approaches and best practices to improve NAS care. These approaches aim to reduce the length of hospital stays, minimize medication use when appropriate, and enhance the overall well-being of affected infants.

One such approach involves promoting increased connection between mothers and babies. Studies have shown that when mothers are actively involved in comforting and caring for their babies, there is less reliance on medication and shorter hospital stays. This approach not only benefits the infant but also supports the mother-infant bond and maternal recovery.

Certain regions heavily impacted by NAS, such as West Virginia, have taken the lead in developing innovative services. Facilities like Lily's Place, an inpatient facility providing care to NAS babies, and Project Hope, designed to help mothers with substance use disorders maintain safe, sober living while caring for their children, have emerged as successful models of care.

By constantly seeking new approaches and best practices, healthcare providers are striving to improve the care and outcomes of infants affected by NAS. These advancements pave the way for more effective and compassionate care, addressing the unique challenges faced by these vulnerable babies and their families.

The ongoing efforts in research, clinical trials, and innovative approaches are crucial in advancing the field of NAS care. By combining knowledge, evidence-based practices, and compassionate approaches, healthcare providers can continue to make a positive impact in the lives of infants born addicted to opioids.

References

• NCBI - Neonatal Abstinence Syndrome
• MarchofDimes - Neonatal Abstinence Syndrome
• National Institutes of Health - Neonatal Opioid Withdrawal Syndrome
• ACOG - Opioid Use Disorder in Pregnancy
• AAMC - Caring for Babies with Opioid Withdrawal