Doctors face growing challenges treating infant addicts and their mothers. In 2010 Maine’s two largest hospitals reported treating or observing 276 infants for neonatal abstinence syndrome -- withdrawal from opiates to which they were exposed in utero --up from 70 in 2005.
Heroin-addicted newborns have been a focus of concern in the medical community for over two decades. A 1988 paper published in the Journal of the National Medical Association reviewed literature on outcomes of newborns born to heroin and methadone-addicted mothers. It reported studies showing the incidence of sudden infant death syndrome in babies born to addicts to be five times higher than control groups. Infants born to heroin-addicted mothers have lower birth weights and head circumference, on average. Other symptoms include yawning, sneezing, sweating, nasal stuffiness, irritability, inability to sleep, vomiting, diarrhea, progressive weight loss and discoloration of the skin due to low blood oxygen levels. Symptoms of heroin withdrawal can manifest as early as 24 hours after birth and usually peak within 48-72 hours. The American Academy of Pediatrics' 1998 policy statement on neonatal drug withdrawal reports that among infants exposed to opioids or heroin in utero, 55 to 94 percent will experience symptoms of withdrawal, including central nervous system irritability and gastrointestinal dysfunction. It estimates that 2 percent to 11 percent of infants withdrawing from opioids suffer from seizures.
Some prescription medications that emerged at the end of the 20th century have produced a fresh wave of drug-addicted infants. Oxycontin, first marketed in 1996, has become widely abused across the United States. A March 2011 New York Times story reported on the growing problem doctors now face treating infants of mothers addicted to Oxycontin and similar prescription painkillers. Oxycontin, like heroin, methadone and morphine, is an opiate. Infants exposed in utero may require treatment for neonatal abstinence syndrome, or NAS, with similar symptoms to those seen in infants exposed to illegal opiates, including tremors and diarrhea. They may need to be slowly weaned off their opiate addiction over the course of weeks. Dr. Mark L. Hudak, a neonatologist in Jacksonville, Florda is helping revise the guidelines published by the American Academy of Pediatrics for treating infant drug withdrawal, which have not been revised since 1998. He bemoans the lack of sound information on the subject: “It’s not like you can go to a Web site that says, ‘This is what should be used by everyone,’ ” Dr Hudak notes. “No one knows what the best approach is.”
For expectant mothers who are addicted to opiates, including heroin and prescription medications such as Oxycontin, doctors recommend patients undergo therapy in which another drug is substituted, rather than cold-turkey abstinence during pregnancy, to reduce the impact of withdrawal on the fetus. Methadone has been the drug of choice for heroin-addicted expectant mothers, and both maternal and neonatal outcomes are improved with methadone therapy as compared with no treatment. Babies born to mothers who are taking methadone may still suffer from neonatal abstinence syndrome, symptoms of which include dysfunction in nervous and respiratory systems and the gastrointestinal tract.
A study published in December 2010 in the New England Journal of Medicine reports promising results with therapy using buprenorphine instead of methadone to treat pregnant addicts. Infants born to mothers treated with buprenorphine rather than methadone required a significantly shorter period of treatment for NAS. New therapeutic options for addicted expectant mothers is somewhat encouraging news, but preventing addiction in the first place remains the best approach. As White House Drug Czar Gil Kerlikowske put it after a May 2011 visit to the Pediatric Interim Care Center in Kent Washington, a facility treating addicted babies, “The most important part, I think, is the education and the awareness.”