MIAMI COUNTY — For newborns who get caught up in the opioid crisis, their first few days of life can come with the extra battle of going through withdrawal if they were born addicted to drugs.
Miami County has seen a handful of drug-dependent newborns over the course of the opioid crisis, including a spike in 2015. At the Upper Valley Medical Center in 2013, there were five babies born addicted to drugs, seven babies in 2014, 12 in 2015, three in 2016, and three in 2017.
The drugs seen with the mothers of these babies include heroin, methadone, mixed drug use such as marijuana/cocaine/heroin, subutex, and opiates, according to Clinical Nurse Specialist Jane Pierce, APRN, at UVMC Women’s and Children’s Services.
“There are many drugs that the fetus can be exposed to,” obstetrician and gynecologist Larry Holland, MD, said. The illegal substances could include heroin, cocaine, methamphetamines, prescription drugs taken for non-medical reasons, and so on.
“Once someone is exposed to these drugs, they will remain in the system for various amounts of time. It is during these times that we can test for and find just what the fetus may have been exposed to,” Holland said.
Heroin will remain positive for 3-4 days in urine, 90 days in hair and about 12 hours in blood. Cocaine will remain positive for three to four days in urine, 90 days in hair and about 24-48 hours in blood. Methamphetamines will remain positive for three to six days in urine, 90 days in hair and about 72 hours in blood. Cannabis will remain positive for seven to 30 days in urine, 90 days in hair and about 14 days in blood.
“We can only test for what is positive at the time of admission as there may have been exposure to other illegal drugs at another point in the pregnancy,” Holland said.
In every pregnancy, every woman begins with a background risk of 3-5 percent of having a baby with a birth defect, Holland said. The added exposure to drugs can affect the fetus in various ways. Holland explained that the consumption of drugs at any point in the pregnancy can potentially influence the fetus, but at what point the drugs were consumed during pregnancy can affect the fetus in different ways.
“It depends not only on the type of drug but also the timing of exposure in the pregnancy,” Holland said. “The baby’s body forms at certain times in each pregnancy which is considered the critical period of development. Therefore, the risk depends on at what stage of the pregnancy the infant is at.”
Using drugs early in the pregnancy has the potential of possibly ending the pregnancy.
“Early in pregnancy exposure carries the greatest risk and can result in major birth defects and miscarriage. Most of the important developmental changes are taking place during this time frame,” Holland said. “In the later weeks of pregnancy, exposure can interfere with growth of the baby and minor birth defects, can cause preterm birth and even fetal death. At the time of birth, exposure to certain drugs can cause withdrawal symptoms in the newborn.”
Those withdrawal symptoms can vary depending on the mother’s drug use, pediatrician Paul Weber, MD, said. The symptoms could be worse if the mother was a chronic user of opiates.
Weber explained that they monitor the infant for a few days to see signs of neonatal abstinence syndrome, the period during which a newborn goes through drug withdrawal. Weber said that they use the Finnegan scoring system to diagnose neonatal abstinence syndrome by assessing the severity of the symptoms on a daily basis, and also monitor the infant’s recovery. Symptoms can include hypersensitivity, excessive crying or irritability, tremors, sneezing, and more.
Infants going through opioid withdrawal are usually treated with methadone, Weber said. They also manage withdrawal in these babies with extra attention like having people spend more time holding them or even giving infant massages.
“They like calm, and they like closeness,” Weber said. “That’s probably equally as important as being on medication.”
As the opioid crisis is still relatively new, doctors are still learning about the lingering effects to children born addicted to drugs or exposed to drugs in the womb as they grow older. “These kids appear to have problems with attention deficit,” Weber said.
Other issues can include behavioral problems, learning disabilities, difficulty with self-regulation, and so on, which can also be influenced by their support system — or lack thereof — at home.
“Those things are going to affect their overall outcome,” Weber said.
In five years, Weber said that doctors will probably know more about what those long-term outcomes will be.
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