Neonatal Abstinence Syndrome – Babies are Born Every Day with a Dependence on Opioids

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Neonatal Abstinence Syndrome is the process of withdrawal from narcotics that a newborn baby who’s born addicted to drugs must endure. The CDC reports that 3.5-8 out of every 1000 newborns are born addicted to narcotics such as heroin, codeine, oxycodone (Oxycontin), methadone or buprenorphine because its mother took such opioids while she was pregnant and transferred her addiction through the placenta.

When the child is born, the stream of drugs is cut off suddenly and the addicted baby now needs to be treated for a withdrawal pattern similar to that of an adult addict who quits cold turkey.

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Symptoms

The symptoms of neonatal abstinence syndrome depend on:

Abusing opiates during pregnancy will cause your baby to be born with a drug dependence.

• The type of drug the mother used
• How the body breaks down the drug
• How much of the drug she was taking
• How long she used the drug
• Whether the baby was born full-term or early (premature)

Symptoms can start between one and three days after birth but may take up to a week before they begin to show. Symptoms can include:

• Blotchy skin
• Diarrhea
• Excessive crying
• Fever and sweating
• Increased muscle tone
• Irritability
• Not feeding well for unexplained reasons
• Rapid breath
• Seizures
• Problems sleeping
• Slow weight gain
• Stuffy nose and sneezing
• Tremors
• Vomiting

Treatment

When treating these withdrawal symptoms, an accurate report of the mother’s drug use is critical, including the name of the drug and the last time she has took it. Also of extreme importance is the child’s overall health and whether the baby was born full-term or premature.

A neonatal abstinence scoring system can be helpful to diagnose and grade the severity of the withdrawal. Using the scoring system, points are assigned for certain signs and symptoms and the severity of each. This scoring may also help in planning treatment.

Of the various neonatal abstinence scoring systems available, the Finnegan scoring system is the most widely used. The Finnegan scale assesses 21 of the most common signs of neonatal abstinence syndrome. Scoring is based on the pathological significance and severity of the adverse symptoms, which sometimes requires pharmaceutical treatment. Practitioners find the Finnegan system relatively easy to use and reliable. The scale also assess the resolution of signs and symptoms after initiating treatment. However, bias and subjectivity sometimes affect the scores, and the thresholds for treatment reported in various literature vary.

Scores are taken every four hours until the child is stable. If the sum of three consecutive scores is equal to or greater than eight, treatment for withdrawal is started. The decision to begin treatment can depend on factors other than just the neonatal abstinence syndrome score, including the reported exposure to the drug, the age of the infant, comorbidities that might influence the score, the type of inpatient or outpatient strategy used, and the experience of the staff member making treatment decisions. Other tests include a toxicology screen of a newborn’s first bowel movements and a urinalysis.

In caring for an infant with neonatal abstinence syndrome, part of the treatment is administering to the infant a drug similar to that which mother used during pregnancy and then slowly decreasing the dose over time. This helps wean the baby off the drug and relieve some withdrawal symptoms. Breastfeeding is also generally helpful, especially a high-calorie formula that provides greater nutrition than regular formula, with smaller portions given more frequently.

Babies suffering from withdrawal are irritable and often have a difficult time being comforted. Swaddling the infant in a blanket can often help comfort the baby. Babies also may need extra calories because of a low birthweight and increased activity due to withdrawal. Intravenous fluids are sometimes needed if the baby becomes dehydrated or has severe vomiting or diarrhea.

To help relieve the overall discomfort and problems caused by withdrawal and to treat severe withdrawal symptoms such as seizures, some babies may need medication. The medication used for treatment is usually in the same family of substances from which the baby is withdrawing. Once the signs of withdrawal are controlled, the dosage is gradually decreased to help wean the baby off the drug. The infant is best cared for in a unit with experienced personnel who can recognize problems, perform constant evaluations, and institute the necessary interventions.

Narcotics Effects on Pregnancy

If you are at a certain level of narcotics usage, your baby may be affected. Your baby may experience birth defects and complications.

What Can Be Done to Prevent Neonatal Abstinence Syndrome?

There’s a very practical answer to preventing neonatal abstinence syndrome. Drug-dependent and drug-abusing expectant mothers must get better treatment and counseling earlier on in their pregnancies. By being informed and starting a rapid treatment program to get them off drugs, they and their newborns will be much healthier and safer.

Unfortunately, less than 17% of mothers reach out for referrals for rehabilitation or drug counseling during their pregnancies. Many fear that the doctors will notify the police, or that, depending on applicable state laws, they might be liable for child endangerment.

Despite the legal liabilities, neonatal abstinence syndrome is generally preventable, and it is up to the mother to get treatment for her addiction as soon as possible.

While newborns suffering from neonatal abstinence syndrome usually stay in the hospital only a few weeks to a month, the stay may be prolonged because the mothers can’t care for their children. Social services often have to find new homes for these infants.

The use of opioids and other drugs during pregnancy can also have adverse effects on the pregnancy itself. Expectant mothers who misuse drugs during pregnancy risk a high chance of their fetuses’ premature birth, birth defects in the brain, spine, or heart, and low birth weight, in addition to neonatal abstinence syndrome. These conditions may impact the baby over time, even into adulthood.

The number of those born with neonatal abstinence syndrome is growing alongside those impacted by addictions to prescription pills. Until something is done to bring down prescription drug abuse nationwide, newborn children are at the mercy of parental substance misuse.

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