One of the most difficult burdens a person coping with addiction faces is the guilt and shame felt from hurting those they love the most. The emotional sting is particularly heartbreaking though when a baby is born addicted to drugs and immediately begins the painful process of withdrawal.
Neonatal Abstinence Syndrome (NAS) is a condition affecting 60 to 80 percent of newborns whose mothers used opiates during pregnancy. The drugs move through the placenta and the baby becomes addicted along with the mother. In 2003, federal data reported 4,991 such cases. By 2013, healthcare professionals around the country had diagnosed 27,315 cases of NAS.
What are the Symptoms of Neonatal Abstinence Syndrome?
The symptoms that newborns with NAS experience vary depending on the type of drug used, the duration of use, and the amount of drugs the mother used during pregnancy. Common symptoms include:
- Vomiting
- Diarrhea
- Loud, high-pitched or excessive crying
- Fever
- Rapid breathing
- Seizures
- Excessive sucking
- Hyperactive reflexes
- Irritability
- Feeding problems
- Sleep issues
- Slow weight gain
- Heavy sweating
- Tremors or shakes
Because Neonatal Abstinence Syndrome has become so common during the current heroin and opiate abuse epidemic, some hospitals around the country have created specialized units to diagnose and treat both the infants and their mothers.
“These are difficult patients,” Dr. Jennifer Bailit, director of the mother’s program at MetroHealth in Northeast Ohio, said in an interview with National Public Radio. “They are complicated, and they have complex social needs. Many practitioners are just not equipped to deal with the breadth and depth of the kind of issues that come with them.”
Doctors have long known that pregnant women with addiction issues risk the likelihood of damaging their unborn child. Dr. Christy Ulleland noticed the link between alcohol exposure and adverse infant outcomes in 1968, which led to the discovery of fetal alcohol syndrome (FAS) a few years later.
What is Fetal Alcohol Syndrome?
Pregnant women with opiate addiction are not encouraged to quit cold turkey because going into withdrawal is dangerous for the child they’re carrying. It increases the risk of premature birth or fetal death.
The American Congress of Obstetricians and Gynecologists suggests that medically assisted therapy with more stable opioids, such as Subutex or Methadone, will stabilize the mother until her child is born. Then both she and the child are able to begin treatment.
What is the Treatment for Neonatal Abstinence Syndrome?
The medical team monitors the infant’s symptoms after birth to gauge the severity of NAS. Treatment for newborn addiction and withdrawal usually includes:
- Intravenous fluids and feeding for dehydrated or vomiting babies
- General amounts of skin-to-skin contact with the child
- A calm and quiet environment
- Dimming the lights to avoid unnecessary visual stimulation
- Gentle rocking
- In some cases, small doses of methadone or Subutex for children who need medically assisted treatment for withdrawal
Diagnosing Neonatal Abstinence Syndrome does present a problem, though. Many pregnant women are less than forthcoming about their opiate addiction, and the healthcare industry is divided on the idea of universal testing for their pregnant patients. Sometimes it’s not until the child is born that a diagnosis can be made, and even then, doctors and nurses have to be educated and aware of the symptoms of NAS to treat it.
An investigative report by the Reuters News Agency in 2015 exposed 110 cases of newborns whose mothers used opiates while pregnant, that died after they were released from the hospital. The news agency also found that only nine states in the U.S. comply with the federal law, passed in 2003, that requires hospitals to notify social workers when a child is born to a mother with an opioid addiction.
Representative John Kline, a Minnesota Republican on the U.S. House Education and Workforce Committee, opened an inquiry to these issues after the Reuters report. “It is clear,” Kline said in a hearing, “that the current system is failing some of our country’s most vulnerable children.” The U.S. Health and Human Services Department has since pledged to revamp its policies and take action.
There are still a lot of questions surrounding how best to treat Neonatal Abstinence Syndrome. Most doctors familiar with NAS appear to have their own approach to treating it, said Dr. Jonathan Davis, Chief of Newborn Medicine at Tuft’s University, in an interview with The Atlantic. The Food and Drug Administration has not even officially approved the use of methadone and morphine on infants.
Only now is one study, led by Dr. Davis, hoping to enroll 180 babies with NAS to research which drugs are most effective and what effect the condition has in the long term.
The bright spot in all this is that generally, most babies recover from Neonatal Abstinence Syndrome in about six to eight weeks. Until society finds a solution to the heroin and prescription painkiller crisis facing the country, though, the physical and emotional toll will continue to play out.
Regarding her daughter’s battle with neonatal abstinence syndrome, one mother told The Atlantic, “I know what she’s feeling and that is the worst part.”
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