Drug withdrawal rate triples in newborns

The number of babies born in the United States with signs of drug withdrawal has tripled in a decade because more pregnant women are using narcotics, according to a new study.

The rate of infants born with withdrawal symptoms reached about one every hour in 2009, researchers report in this week’s issue of the Journal of the American Medical Association.

"What we found was that from 2000 to 2009, the number of babies having drug withdrawal increased by three times," said the study’s lead author, Dr. Stephen Patrick of the University of Michigan's division of neonatal-perinatal medicine in Ann Arbor.

Babies with withdrawal, called neonatal abstinence syndrome (NAS), commonly show:

• Irritability.
• Difficulty feeding.
• Difficulty breathing.
• Low birth weight.

For the study, Patrick and his co-authors reviewed hospital billing data from across the U.S.

They looked at how many women were using opiates at the time of delivery as well as whether the newborns showed drug withdrawal symptoms.

In 2009, at least 1,057 babies were born in Canada with NAS, an 18-per-cent increase over the year before, according to the most recent figures available from the Canadian Institute for Health Information.

Complex and costly hospital stays

The incidence of the syndrome increased from 1.20 per 1,000 hospital births per year in 2000 to 3.39 per 1,000 hospital births at the end of the decade, the researchers found.

Not all babies born to women who used opiates during pregnancy showed symptoms.

The newborns included babies like Savannah, whose mother stopped abusing painkillers and switched to prescribed methadone early in pregnancy.

Savannah has trouble sleeping peacefully, sometimes cries all  night, and has had diarrhea and trouble feeding.

"It's really hard, every day, emotionally and physically," said her mother Aileen Dannelley, 25. "It's really hard when your daughter is born addicted."

Dannelley said a neighbour introduced her to crack at age 14 and she's also abused Vicodin prescribed to her for back pain as well as other prescription painkillers and heroin.

The hospital length of stay for newborns diagnosed with the syndrome averaged 16 days and remained about the same throughout the study. In Canada, the average hospital stay for for NAS infants was 15 days, CIHI said.  

"In conclusion, newborns with NAS experience longer, often medically complex and costly initial hospitalizations," the study authors wrote.

The researchers said many pregnant women were legitimately taking pain-relieving opiates prescribed to them.

Opiates 'overprescribed'

The researchers said they want more done to find ways of protecting the unborn from the drugs that offer pain control for cancer and chronic pain.

A journal editorial accompanying the study called opiate medications "overprescribed, diverted and sold illegally, creating a new opiate addiction pathway, and a public health burden for maternal and child health."

Marie Hayes of the University of Maine, Orono, and Dr. Mark Brown, chief of pediatrics at Eastern Maine Medical Center in Bangor agreed with the researchers that research needs to establish the best ways to treat opiate dependence in pregnancy. That may include starting methadone treatment early in pregnancy, monitoring alcohol use and providing psychiatric care.

The babies are dependent on methadone or other opiates because of their mothers' use during pregnancy. The infants are given small doses of methadone to wean them off. That's safer than cutting them off cold turkey, which can cause dangerous seizures and even death, Brown said.  

Scientists are gaining clues to dependence by studying how opiates cross the placenta and analyzing infant stool samples.

The research was funded by the Robert Wood Johnson Foundation Clinical Scholars Program.