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KY THE COURIER-JOURNAL | SUNDAY, AUGUST 26, 2012 | A11

PRESCRIPTION FOR TRAGEDY
Source: Kentucky Injury Prevention and Research Center, University of Kentucky, Kentucky Office of Drug Control Policy STEVE REED/THE COURIER-JOURNAL
29
67
99
143
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
3 43
730
MATERNAL
OPIATE USE
Per 1,000 U.S. hospital births
SOURCE: “Neonatal Abstinence Syndrome
and Associated Health Care Expenditures,
”Dr. Stephen Patrick et al., May 2012,
Journal of the American Medical
Association
1.19
2000 2009
5.63

WHAT IS IT?
Agroupof problems that occur inanewbornwhohas beenexposed
toaddictivedrugs whileinamother’s womb. Neonatal abstinence
syndromecanlast fromoneweektosix months.
CAUSES
Apregnant womantakes addictiveillicit or prescriptiondrugs suchas
narcotics, benzodiazapines, amphetamines or others. Thesepass through
theplacentatothebaby duringpregnancy, andthebaby becomes
addictedalongwiththemother. At birth, thebaby is still dependent on
thedrug, but becausethebaby is nolonger gettingthedrug, symptoms
of withdrawal may occur.
SYMPTOMS
Symptoms aredependent onthetypeof drugthemother used, how
muchshewas takingandhowher body breaks downthedrug. They
canbegin1-3days after birthor may take5-10days toappear.
They may include:
NEWBORN
ADDICTS
Neonatal Abstinence Syndrome
TREATMENT FOR NEWBORNS
Depends onthedruginvolved, whether thebaby is prematureandthe
baby’s overall health.
Watchingthebaby for signs of withdrawal, feedingproblems, and
weight gain. Babies whovomit or whoarevery dehydratedmay needto
get fluids throughavein.
Calmingoften-fussy infants by gentlerocking, reducingnoiseandlights,
swaddlinginablanket.
Somebabies withseveresymptoms needmedicine, suchas morphineor
methadone, totreat withdrawal symptoms. Thedoctor may prescribe
theinfant adrugsimilar totheonethemother usedduringpregnancy
andslowly decreasethedose. This helps weanthebaby off thedrugand
relievesomewithdrawal symptoms. Opiates suchas morphineor dilute
tinctureof opiumshouldprobably beusedas initial treatment for opiate
withdrawal innewborninfants. Whenasedativeis needed, phenobarbi-
toneis preferred.
Breastfeedingmay alsobehelpful. Babies withpoor feedingor slow
growthmay needahigh-calorieformulathat provides greater nutrition,
or smaller portions givenmoreoften.
“They are just agitated.
They are screaming.
They have tremors. Their
faces – you have the
grimace. They’re in pain.
…Sometimes the babies
have seizures. We hate
it; I’ll be honest about
it. ... It breaks my heart
to see these babies go
through withdrawal.”
TONYA ANDERSON,
Infant development/
touch therapist nurse at
Kosair Children’s Hospital
“We knew that it was
common, but we would
not expect this problem
would have tripled
(nationally) in the last
decade. There are not
many medical problems
that have tripled in a
decade – not obesity,
not heart disease, not
diabetes.”
DR. MATTHEW DAVIS,
Associate professor at the
University of Michigan
“This is driving costs in
so many areas up from
a fiscal standpoint.
Then you look at the
children who are born
withdrawing from drugs
– that’s a whole different
cost. That’s the human
cost.”
AUDREY TAYSE HAYNES,
Secretary of the Kentucky Cabinet
for Health & Family Services
Blotchy skincoloring(mottling)
Diarrhea
Excessiveor high-pitchedcrying
Excessivesucking
Fever
Hyperactivereflexes
Increasedmuscletone
Irritability
Poor feeding
Rapidbreathing
Seizures
Sleepproblems
Slowweight gain
Stuffy nose, sneezing
Sweating
Trembling
Vomiting
Tonya Anderson, an infant development and touch therapist nurse
at Kosair Children’s Hospital, comforts a newborn with substance de-
pendency. “Sometimes all they really need is someone to hold them,”
she said. “I can do it for hours, so if they have a child that just can’t be
consoled, they will usually call me.” ALTON STRUPP / COURIER-JOURNAL
WAYS PARENTS CAN HELP
SWADDLING
Wrappingyour baby snugly inablanket will helphimcontrol movements andcomfort him.
IHE"C"PO5lIlON º Holdingyour baby ina“C”
positionwill helphimrelax. Holdhimsecurely andtuckhis
headandlegs intoa“C”shape, sothat his chinrests near
his chest, witharms near thecenter of his chest. Thebaby’s
backshouldberounded, withlegs tuckedtowardhis belly.
Wrapthebaby inablanket tohelphimstay inthis position.
1. Put theblanket downinadiamondshape.
2. Foldthetopcorner down.
3. Placebaby ontheblanket withthetunrneddowncorner at thelevel of baby’s ears.
4. Gently bendbaby’s arms closetohis or her body sothat thehands arenear themouth.
5. Tuckonsideof theblanket snugly aroundbaby.
6. Turnupthebottomcorner.
7. Tuckthelast sidearoundbaby.
7 6 1-5
PAIIlNG º Pat thebaby’s
diaperedandblanketedbottom.
(This cansometimes betoomuch
for themost sensitivebabies.)
AVOIDFAST, JERKY
NOVENENI5 º Such
movements canbetoostimulat-
ingtothebaby’s nervous system.
Slowandrhythmic swayingis
calming.
Source: Kosair Children’s Hospital; Neonatal Abstinence Regional Hospital Coaltion Photos courtesy of Peterborough Regional Health Centre, Ontario, Canada
KENTUCKY HOSPITALIZATIONS
FOR NEWBORN DRUG
WITHDRAWAL SYNDROME
Hospitalizations involving a diagnosis for
Neonatal Abstinence Syndrome
Per 1,000 U.S. hospital births
INCIDENCE
OF NEONATAL
ABSTINENCE
SYNDROME
1.2
2000 2009
3.39
SOURCE: Journal of the American
Medical Association, May, Dr. Stephen
Patrick et. al
TREATMENT FOR PREGNANT MOMS
Thecurrent standardof carefor opioiddependenceis referral for
therapy withmethadone, but emergingevidencesuggests
buprenorphinealsoshouldbeconsidered. Abruptly stoppingopioids
canresult inpretermlabor, fetal distress or fetal death.
TESTS
Thedoctor will askquestions about amother’s druguse. Tests todiagnose
withdrawal inthebabymayincludeaneonatal abstinencesyndrome
scoringsystem, whichassigns points basedoneachsymptomandits
severity; atoxicologyscreenof thefirst bowel movements andaurinetest.
COMPLICATIONS
Birthdefects, lowbirthweight, prematurebirth, small headcircumfer-
enceandsuddeninfant deathsyndrome.
LONG-TERM ISSUES
Recent dataonlong-termoutcomes of fetal exposuretoprescription
drugs arelimited, althoughsomedoctors suggest neurobehavioral
problems or AttentionDeficit andHyperactivity Disorder arepossible.
Time: 08-25-2012 18:53 User: jharkness PubDate: 08-26-2012 Zone: KY Edition: 1 Page Name: A11 Color: Cyan Magenta Yellow Black