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Sydney Black

Professor Roberts

HLTH-1050

27 November 2017

Born Addicted

For my research paper I wanted to focus on the affects maternal opioid use has on infants,

more specifically known as, Neonatal Abstinence Syndrome, or NAS for short. Everyone should

be aware of the drug epidemic that our nation is facing. Yet, often enough there is one group of

opioid addicts left in the dark, our newborns. We as a nation need to recognize the innocent lives

that are being affected, and that many never had a chance to begin with.

First and foremost, Neonatal Abstinence Syndrome is a group of conditions that a baby

experiences if continuously exposed to drugs in the womb,(March of Dimes). After birth they

exhibit signs and symptoms of going through withdrawals. The most prevalent drug associated

with NAS is opioids. Opioids are drugs with analgesic properties that act in the brain like opium,

(Levinthal, 119). The drug comes in many forms, Codeine, Hydrocodone, Morphine,

Oxycodone, and Tramadol,(Levinthal, 136). The most infamously known form of opioids is the

street drug heroin. For many, it is the drug that their babies are born withdrawing from.

The signs of NAS can show up as late as 72 hours after birth and can be very upsetting to

witness. First, tests must take place to determine the child and the mothers standing. In many

cases the mother might not be honest regarding her drug use with the medical team. Tests can be

ran on the newborn's urine and meconium (the first stool), or the best option is the infants

umbilical cord tissue,(NCPOEP).This determines the infants need for pharmacologic treatment.
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Symptoms include, but not limited to, tremors, convulsions, overactive reflexes, and

tight muscle tone,(NIDA). The infants are fussy, cry excessively, and are inconsolable at times.

They also exhibit poor feeding/sucking, are slow to gain weight, have breathing problems, fever,

blotchy skin, trouble sleeping, and lots of yawning. As if not enough, the infants also suffer from

diarrhea, throwing up, stuffy noses, and lots of sneezing,(March of Dimes). In extreme cases the

infants can cry just from being touched.

All of these symptoms are scored based on, The Finnegan Neonatal Abstinence Scoring

System. A form is filled out by healthcare professionals based on the symptoms and their

frequency for the duration of the infant's stay in the NICU, and treatment is based on those

scores. The symptoms are monitored every three to four hours, focusing on supportive care.

Which entails creating a low stimulating, quiet, and dark environment, (NCPOEP). For a

measurable comparison, how a NAS infant is feeling, equates to a debilitating migraine in adults.

The treatment need for these babies is extensive and time consuming.

As stated before, their status is check every three to four hours, and then given morphine,

methadone, or buprenorphine to ease the pain of withdrawals. Once under control, the amount of

morphine is slowly weaned from the baby, until they can function without it, (March of Dimes).

Dehydration also becomes a problem because babies with NAS may experience throwing up and

diarrhea, healthcare professionals then administer fluids through an IV, (March of Dimes). The

North Carolina Pregnancy & Opioid Exposure Project suggests, Swaddling the infant to inhibit

self-stimulation...encouraging skin-to-skin contact for comfort and promotion of the infants

attachment to the mother/caregiver, and swaying/rocking for comfort techniques,(NCPOEP). To

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ensure the best treatment of these babies there needs to be an open line of communication

between health workers and the caregivers/parents.

In many situations, the OB-GYN of the mother is notified of the drug use during the

beginning months of pregnancy, and they have several options to choose from. They can put the

mother on a monitored dose of Methadone throughout gestation, recommend an NA group, or

trust what the mother says. Either way, it is mandatory by law in fifteen states, Utah included,

that doctors report cases of drug use during pregnancy to the proper agencies, (Miranda).

The question on how hospitals and doctors deal with babies born showing signs of NAS,

is an ethical concern. We know they must report the drug use to authorities, but depending on if

the baby tests dirty after birth, state officials come in to ensure proper execution on the situation

at hand. They address concerns whether or not the baby is safe under the care of parents, if the

infant needs to be placed in a new home, and if reunification is possible, (Programs and

Services). The hospital reports test results back to the social workers and they make the best

decision for the child.

Every year there are more and more infants needing treatment for Neonatal Abstinence

Syndrome, and the cost is also rising. NBC News gives this jarring fact, A recent analysis by

the Centers for Disease Control estimated that nearly six out of every 1,000 infants born in the

U.S. are now diagnosed with NAS. However, experts say that rate is likely higher, as not all

states regularly collect such data,(Rappleye). This gives us a visual of how big the problem is

and what our nation's future generations will be like. Furthermore, the National Institute on

Drug Abuse states, There was a five-fold increase in the proportion of babies born with NAS

from 2000 to 2012, when an estimated 21,732 infants were born with NAS equivalent to one
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baby suffering from opiate withdrawal born every 25 minutes,(Abuse). With this fact, we are

given a time frame in which these suffering babies are born, we can see why the number is ever

increasing.

Also important is the amount of time these infants are staying in the hospital. It is an

average of 16 days, whereas a non-NAS infant stays an average of 2,(Abuse). Let it also be

known, that the average cost of treatment for babies suffering from NAS is a shocking

$60,000.00 give or take, (Rappleye). This bill, in most cases is paid for by the states Medicaid

programs, which reflects on the tendency for lower income women to be opiate abusers. The

admissions to hospitals for NAS as increased fourfold, and is costing the United States nearly

$316 million,(Corr).

After looking at the suffering that these tiny victims go through just after entering the

world, a lot is still unknown about their future. Yet, we need to anticipate these challenges that

they may face to be better equipped to handle the aftermath of maternal opioid abuse. These

babies born addicted have higher risks for developing behavior issues, many even fall on the

autism spectrum. Developmental babies with NAS tend to reach milestones slower, grow at

slower rates, and typically are born prematurely, further increasing delays, ( Long-Term).

Doctors and caregivers should work closely together to ensure the best care for the child.

There are specific long-term problems that these children may face. Otitis Media, which

according to MedicineNet.com is, Inflammation of the middle ear characterized by the

accumulation of infected fluid in the middle ear. They also have higher risks of developing

vision problems, motor development problems, and risk of SIDS, (Long-Term). Children that are

born from such distressful situations and stay with their birth parents also have a higher risk of
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being further abused and neglected. Stability and support is what NAS babies thrive on, and

typically this situation is the complete opposite, which heightens their risks of becoming a future

drug user themselves.

It is of vital importance that these infants and their parents get the help that they need.

First and foremost, in a preventative matter pregnant addicts should reach out to professional if

they need help. They should be set up with an OB-GYN as soon as possible and begin to discuss

their options for treatment. If the mother is low-income earning, or unemployed they have

programs that can help ensure her the healthiest pregnancy. W.I.C is a program that provides

services and supplemental foods to pregnant women, new mothers, infants and children, each

program differs by state.

Baby your Baby, are experts from Intermountain Healthcare and the Utah Department of

Health share their knowledge, advice and tips for pregnant women and new parents, the program

also offers financial aid. The House of Hope in Provo, Utah is another big help for pregnant

addicts and their road to rehabilitation . The House of Hope Provo describes its mission as, A

private, non-profit organization offering residential, day treatment, and outpatient substance use

disorders treatment for adult women transitioned to an intensive substance use recovery

residential facility for women, pregnant women and mothers. At this program mothers are

allowed to have their babies stay with them and go through recovery while still able to care, and

learn how to parent their child.

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Neonatal Abstinence Syndrome is one of the many aftershocks of our nations drug

epidemic. The future of our nation's most vulnerable is unknown, and the numbers only seem to

be increasing. Early intervention and environmental stability are important factors towards a

solution, and the rehabilitation of these infants and their parents.

Works Cited

Abuse, National Institute on Drug. Dramatic Increases in Maternal Opioid Use and Neonatal

Abstinence Syndrome. NIDA, 1 Sept. 2015,

www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-m

aternal-opioid-use-neonatal-abstinence-syndrome.

Corr, T E, and C S Hollenbeak. The Economic Burden of Neonatal Abstinence Syndrome in the

United States. Addiction (Abingdon, England)., U.S. National Library of Medicine, Sept.

2017, www.ncbi.nlm.nih.gov/pubmed/28612362.

House of Hope: About Us. House of Hope, 2017, www.houseofhopeut.org/about-us.php.

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Levinthal, Charles F. Opioids: Opium, Heroin, and Opioid Pain Medications. Drugs, Behavior,

and Modern Society, 8th ed., Pearson, 2014.

Long-Term Outcomes of Infants With Neonatal Abstinence Syndrome. Long-Term Outcomes

of Infants With Neonatal Abstinence Syndrome | Seattle Children's Hospital,

www.seattlechildrens.org/healthcare-professionals/education/continuing-medical-nursing

-education/neonatal-nursing-education-briefs/long-term-outcomes-of-infants-with-nas/.

Medical Definition of Otitis Media. MedicineNet,

www.medicinenet.com/script/main/art.asp?articlekey=8912.

Miranda, Leticia, et al. How States Handle Drug Use During Pregnancy. Pro Publica, 30 Sept.

2015, projects.propublica.org/graphics/maternity-drug-policies-by-state.

Neonatal Abstinence Syndrome (NAS). March of Dimes, June 2017,

www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx.

Neonatal Abstinence Syndrome (NAS). NCPOEP,

www.ncpoep.org/guidance-document/neonatal-abstinence-syndrome-overview/neonatal-

abstinence-syndrome-nas/.

NIDA. "Heroin." National Institute on Drug Abuse, 13 Nov. 2014,

https://www.drugabuse.gov/publications/research-reports/heroin. Accessed 7 Dec. 2017.

Programs and Services. Child & Family Services, dcfs.utah.gov/.

Rappleye, Hannah, et al. Born Addicted: The Number of Opioid-Addicted Babies Is

Soaring.NBCNews.com, NBCUniversal News Group, 9 Oct. 2017,

www.nbcnews.com/storyline/americas-heroin-epidemic/born-addicted-number-opioid-ad

dicted-babies-soaring-n806346.