Better treatments needed for opiate-addicted newborns, researchers say

Nov 27 2017

Better treatments needed for opiate-addicted newborns, researchers say

The National Institutes of Health (NIH) is funding a new study to analyze treatment options for newborns with opioid withdrawal syndrome.

While states have been reporting more cases of the syndrome, the NIH says health care providers in the United States lack standard, evidence-based treatments for the condition. The study, called Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW), is intended to enable better, standardized clinical care of these infants.

ACT NOW is funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the NIH Office of the Director’s Environmental Influences on Child Health Outcomes (ECHO) Program.

The Centers for Disease Control and Prevention has reported that the incidence of neonatal abstinence syndrome increased to 6 per 1,000 hospital births in 2013, up from 1.5 per 1,000 in 1999.

“This project will allow researchers to evaluate the impact of neonatal opioid withdrawal syndrome across the country and to develop a multi-site clinical trial in areas hit hard by the opioid crisis,” Dr. Matthew W. Gillman, Environmental Influences on Child Health Outcomes director, said in a statement.

NICHD Director Dr. Diana W. Bianchi said ACT NOW will “supplement research on opioids and pregnancy outcomes by addressing critical gaps on how best to treat and manage opioid withdrawal syndrome in newborns.”

The National Center on Substance Abuse and Child Welfare, estimates that 10 to 11 percent of all pregnancies involve a mother with a substance use disorder – about 440,000 affected infants. The American College of Obstetricians and Gynecologists (ACOG) has cited an estimate that 1 percent of pregnant women are using opiates. But, urine analysis performed on pregnant women at one metropolitan teaching hospital showed 2.6 percent usage.

The babies of addicted mothers are sometimes born with birth defects. Studies show a possibility of heart defects in babies born to codeine-addicted mothers. However, the same study performed with mothers addicted to heroin or pain pills showed no heart defects. With any type of opiate use, neural tube defects can occur such as spina bifida, as well as rare defects of the newborn’s abdominal wall.

Opiate addiction during pregnancy can also cause other complications. The ACOG reports that mothers who use heroin have higher rates of low birth-weight babies; premature separation of the placenta from the uterus; premature labor; meconium circulating throughout the uterus; and fetal death.

Neonatal Abstinence Syndrome (NAS) occurs in 55 to 94 percent of babies born to opioid-addicted mothers. The level of addiction depends on what drug the mother has been using, how much per day, and for how long.

Symptoms include splotchy skin, irritability and excessive crying, diarrhea, hyperactive reflexes, excessive sucking or poor feeding, sleep problems, sweating, trembling, vomiting, stuffy nose, increased muscle tone, fever, and even seizures. Symptoms are less drastic in babies whose mothers took Suboxone or methadone under medical supervision during the pregnancy.

A study conducted a few years ago found that incidence of NAS is rising in the United States. There was a 500 percent increase in the proportion of babies born with NAS from 2000 to 2012, to an estimated 21,732  —equivalent to one infant suffering from opiate withdrawal born every 25 minutes.

Also, newborns with NAS were more likely than other babies to also have low birth weight, and respiratory complications. The number of delivering mothers using or dependent on opiates increased almost 500 percent from 2000 to 2009, to an estimated 23,009. In 2012, newborns with NAS stayed in the hospital an average of 16.9 days (compared to 2.1. days for other infants.