Addiction symptoms inflict newborns

While newborn babies cannot inherently be born with an addiction if mothers use drugs during pregnancy they can, however, develop neonatal abstinence syndrome or NAS, according to the National Institute on Drug Abuse. Chautauqua County is no exception.

“It’s definitely been a documented problem here,” said Christine Schuyler, director of county health and human services.

Schuyler said the county noted the problem in 2014 after a community health assessment. Then, the region’s statistics for mothers testing positive during toxicology screenings before giving birth was almost quadruple the New York State average at the time. From 2005 to 2014, the county’s newborn drug-related diagnosis rate has increased with slight dropoffs in 2011 and 2013.

Technically, babies cannot be classified as addicted because the term is defined by a person that seeks out and continues to use drugs regardless of the negative impacts. Because newborns are relying on care from hospital staff, they are not considered to be addicted. Despite the terminology, babies are still born with addiction symptoms.

NAS is observed when newborns were exposed to various types of drugs and experience withdrawal symptoms as a result. The problem is most prevalent when mothers use opioids during pregnancy. Those opioids include pain relievers and heroin. The list of specific opioids that can lead to addiction includes codeine, hydrocodone, morphine, oxycodone, tramadal, antidepressants and benzodiazepines.

There has been an uptick with babies born with NAS since 2013, according to NIDA. In 2013, one out of 6,000 newborns were treated for NAS. The increase almost tripled how many births experienced NAS in 1999 of 1.5 births out of 1,000.

Babies impacted by NAS can show signs of withdrawal symptoms such as tremors, diarrhea, fever, irritability, seizure, sneezing, excessive crying, twitching and difficulty breathing and feeding. Stanford Children’s Health warns that NAS could result in poor intrauterine growth, premature birth and possible birth defects.

Schuyler said the varying symptoms makes diagnosing it even more difficult. Additionally, the symptoms often are not observed until 48 to 72 hours after birth when the newborn is already sent home with the family.

“Those babies are at higher risk for abuse and neglect,” Schuyler said. “They tend to be harder to consul. They’re poor feeders — a lot of crying.”

On top of NAS symptoms, the impact of can be much greater. Babies suffering from NAS are more susceptible to other complications after birth including low-birth weight, jaundice, extended stay in the intensive care unit and needing additional medical treatment.

Pregnant women who want to be treated for an opioid addiction can seek safe help during pregnancy to prevent any harmful side effects passing to the baby. According to NIDA, using buprenorphine and methadone, medicines used to treat addiction, safely and effectively treats addicts who are pregnant.

If pregnant women are not treated, babies born with NAS can be treated by being administered with proper medicine to alleviate discomfort.

Babies with NAS can be treated with various methods. Consuming medicines to combat the symptoms with smaller doses as symptoms decrease is recommended. However, the medicines used to treat the withdrawal symptoms include burprenorphine, methadone and morphine, an opioid that causes NAS.

Administering fluids to the baby through IV and utilizing higher-calorie baby formula helps fend off withdrawal symptoms as well. Marchofdimes.org states that babies who undergo treatment usually kick any symptoms within five to 30 days. Additional home remedies include keeping the affected baby in a dimly lit room, swaddling the baby, giving skin-to-skin care and breastfeeding.

Prevention for babies impacted by NAS is simply the sobriety of pregnant women. NIDA recommends women who plan to have a baby to get clean before pregnancy or seek help once they are pregnant.

Determining if a newborn has NAS is based upon its scoring system, according to marchofdimes.org. March Of Dimes advocates for the health of mothers and babies in the U.S.

Within the parameters of the scoring system, a point is assigned in accordance to each observable symptom and its level of severity. Further medical treatment is assigned based on the result of the scoring system. Additional testing includes a meconium and urine test.

But even with all the testing, some newborns slip through the cracks. Schuyler said her department would like to see universal testing of all babies born in Chautauqua County. Currently, Brooks Memorial Hospital universally tests all pregnant women. If an individual tests positive for a substance then the newborn is tested. At UPMC Chautauqua, pregnant women and infants are tested on a criteria-based system.

Schuyler wrote a letter to former state Sen. Cathy Young calling attention to the problem in the area in 2017. The letter details the impacts of pregnant women who abuse substances before birth. Additionally, the letter advocated for universal testing throughout the state. Schuyler speculated that one reason for the county’s rank being the second highest in state among other counties is due to the lack of testing and reporting in other counties.

At UPMC, Sal Buonaiuto, chairman of the department of pediatrics, said that 5 to 10 percent of pregnant women the hospital admits have a history of substance use. Pregnant women from the ages 18 to 30 more frequently test positive when compared to those older than 30. Buonaiuto noted that the number of babies with NAS is likely lower as there are not always withdrawal symptoms when mothers test positive for a substance.

Buonaiuto said women test positive for marijuana more than any other substances during pregnancy on average.

“I think (marijuana) is relatively inexpensive and relatively easy to get,” he said. “Socially, it’s considered more acceptable than what we would term hardcore drugs like cocaine or heroine. That’s why we see it more (in pregnant women).”

While marijuana use does not cause NAS, it does, however, have an impact on the baby, Buonaiuto and Schuyler agreed. Low-birth weight for infants and cognitive problems for children later in life are among the biggest concerns of using marijuana during pregnancy.

“They certainly can have development issues down the road,” he said regarding the child’s brain.

Overall, Buonaiuto said it’s difficult to identify which substance is causing what problems because often there is a slew of substances in a pregnant women’s system when they test positive.

“Rarely there is just one substance,” he said.

As for alternatives to using drugs or striving for sobriety, seeking help is key. For pregnant women continuing to use alcohol or drugs during pregnancy, Buonauito said it’s clear the baby isn’t their No. 1 concern. He said he appreciates women who seek addiction help after finding out their pregnant.

“They’re doing all the right things ensure the health of the child,” he said. “I applaud every mother who does that. I know it’s not easy.

“What bothers me is when people on drugs aren’t getting the help and then the baby isn’t the most important thing.”