Every Hour a Baby is Born Addicted to Opioids

Every hour, a baby is born addicted to opioids. Explore the impact, treatment, and initiatives combating this heartbreaking crisis.

Every Hour a Baby is Born Addicted to Opioids

Every Hour a Baby is Born Addicted to Opioids

Understanding Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) is a condition that occurs in newborns who have been exposed to opioids while in the womb. The impact of maternal opioid use during pregnancy can have significant consequences for both the mother and the baby. Let's explore the impact of maternal opioid use and the associated risks and complications.

Impact of Maternal Opioid Use

The number of pregnant women with opioid use disorder (OUD) has been on the rise, leading to an increase in the number of neonates with NAS. Between 1999 and 2014, the prevalence of OUD among pregnant women increased from 1.5 to 6.5 cases per 1,000 hospital births, resulting in a substantial rise in the number of infants affected by NAS, from 1.2 to 8.0 per 1,000 hospital births.

Maternal opioid use during pregnancy can have various effects on the developing fetus. Infants with prenatal opioid exposure are at an increased risk for premature birth, lower birth weight, and a smaller head circumference. Additionally, prenatal opioid exposure can lead to abnormal brain development, including macrostructural and microstructural abnormalities, altered brain functioning, and smaller head circumference [1].

Risks and Complications

In addition to the physical effects, infants born with NAS may experience a range of withdrawal symptoms as their bodies adapt to the absence of opioids. These symptoms typically manifest within the first few days of life and can include tremors, irritability, excessive crying, poor feeding, sleep disturbances, and gastrointestinal issues.

The severity and duration of NAS symptoms can vary depending on factors such as the type and amount of opioids used, the length of exposure, and the infant's overall health. Some studies have shown that infants exposed to maternal opioids, as well as other substances like benzodiazepines, tobacco, selective serotonin reuptake inhibitors, gabapentin, marijuana, or cocaine, may have a higher likelihood of requiring pharmacotherapy for NAS.

It is important for healthcare providers to closely monitor infants with NAS, provide supportive care, and, in severe cases, administer pharmacological treatment to alleviate withdrawal symptoms. Early identification and appropriate management of NAS are crucial for ensuring the best possible outcomes for affected infants.

Understanding the impact of maternal opioid use and the associated risks and complications of NAS is essential to promote awareness, prevention, and effective management of this condition. Through education, support, and access to comprehensive care, we can work towards reducing the incidence of NAS and providing better outcomes for both mothers and their babies.

Treatment Approaches for NAS

When it comes to addressing neonatal abstinence syndrome (NAS), there are various treatment approaches available. These approaches aim to alleviate the symptoms experienced by newborn infants due to maternal opioid use. Treatment for NAS typically involves a combination of pharmacotherapy and non-pharmacological interventions.

Pharmacotherapy for NAS

Pharmacotherapy refers to the use of medications to manage the withdrawal symptoms associated with NAS. The choice of pharmacological agents may vary depending on the severity of symptoms and individual patient factors. However, it is important to note that there is limited evidence available regarding the effectiveness and safety of using opioids for the treatment of NAS in newborn infants.

In cases where pharmacotherapy is deemed necessary, a single pharmacological agent, such as an opioid or sedative, may be administered. The goal of treatment usually involves reducing a standardized score of NAS from a clinically significant level to a clinically 'safe' level [2]. However, if an infant fails to respond adequately to a combination of a single pharmacological agent and non-pharmacological interventions, a second agent may be considered [2].

Non-pharmacological Interventions

Non-pharmacological interventions play a crucial role in the management of NAS and are often used in conjunction with pharmacotherapy. These interventions aim to provide comfort and support to infants experiencing withdrawal symptoms. While there is insufficient evidence to determine the effectiveness and safety of non-pharmacological interventions alone compared to a combination of non-pharmacological interventions and pharmacological agents, they are still considered an important component of treatment [2].

Non-pharmacological interventions for NAS may include:

  • Swaddling: Wrapping the infant snugly in a blanket to provide a sense of security and reduce agitation.
  • Non-nutritive sucking: Allowing the infant to suck on a pacifier or a clean finger to provide comfort and soothe.
  • Environmental modifications: Creating a calm and quiet environment to minimize external stimuli and promote relaxation.
  • Gentle rocking or movement: Using gentle movements to help calm the infant and alleviate discomfort.
  • Skin-to-skin contact: Placing the infant on the mother's or caregiver's bare chest to promote bonding and provide a sense of warmth and security.

It is important to note that the treatment approach for NAS should be individualized, taking into consideration the specific needs and circumstances of the infant. Close monitoring, multidisciplinary care, and regular reassessment are essential components of the treatment process.

By combining pharmacotherapy and non-pharmacological interventions, healthcare professionals aim to alleviate the symptoms of NAS and support the overall well-being of affected newborns.

Breastfeeding and NAS

Breastfeeding plays a significant role in the care and treatment of infants with Neonatal Abstinence Syndrome (NAS). While every case of NAS is unique, breastfeeding offers several benefits for opioid-exposed infants, including less severe withdrawal symptoms, reduced need for pharmacotherapy, and shorter hospital stays [1].

Benefits of Breastfeeding

Breast milk provides essential nutrients and antibodies that support the overall health and development of newborns, including those affected by NAS. Here are some key benefits of breastfeeding for infants with NAS:

  1. Less severe withdrawal: Breastfeeding has been associated with a reduction in the severity of withdrawal symptoms in opioid-exposed infants. The skin-to-skin contact, warmth, and comfort provided by breastfeeding can help soothe the baby and alleviate withdrawal discomfort.
  2. Reduced need for pharmacotherapy: Breastfeeding has been found to decrease the need for pharmacological interventions to manage withdrawal symptoms. The composition of breast milk, along with the emotional bond between mother and baby, can help regulate the infant's nervous system and promote a sense of calm.
  3. Shorter hospital stay: Breastfed infants with NAS may experience shorter hospital stays compared to those who are not breastfed. The nutritional and immunological benefits of breast milk can support the baby's recovery and overall well-being, potentially expediting the transition to a non-hospital care setting.

Considerations for Breastfeeding

While breastfeeding is generally encouraged for newborns with NAS, certain circumstances may require careful evaluation and consideration. Here are some factors to keep in mind:

  1. Specific circumstances: In some cases, breastfeeding may not be recommended if there are specific circumstances present, such as illicit drug use, multiple drug use, or HIV positivity. Healthcare professionals should assess individual situations and provide guidance accordingly to ensure the safety and well-being of both the mother and the baby [3].
  2. Treatment and monitoring: Most babies with NAS require treatment in the hospital after birth, and some may need care in the newborn intensive care unit (NICU). Close monitoring and specialized care are essential to address withdrawal symptoms and potential complications associated with NAS. Healthcare providers will assess the baby's progress and provide appropriate interventions to support their recovery.

Breastfeeding, when medically appropriate, can offer benefits to infants with NAS. However, it is crucial for healthcare professionals to evaluate each case individually and provide guidance on the most suitable feeding approach for the well-being of both mother and baby. The multidisciplinary care team, including doctors, nurses, lactation consultants, and social workers, plays a pivotal role in supporting and educating mothers about the benefits and considerations of breastfeeding in the context of NAS.

Statistics and Trends

The prevalence of Neonatal Abstinence Syndrome (NAS) has been on the rise in recent years, reflecting the growing impact of maternal opioid use on newborns. This section will explore the increasing cases of NAS and the variations in NAS rates across different states.

Rising Cases of NAS

The statistics surrounding NAS are concerning. Every hour in the United States, a baby is born with NAS due to exposure to opioids during pregnancy, highlighting the urgent need for intervention and support. Between 1999 and 2014, the number of pregnant women with opioid use disorder (OUD) increased from 1.5 to 6.5 cases per 1,000 hospital births. This increase has led to a steep rise in the number of neonates diagnosed with NAS, from 1.2 to 8.0 per 1,000 hospital births during the same period.

To put it into perspective, approximately one baby is diagnosed with NAS every 24 minutes in the United States, amounting to more than 59 newborns diagnosed with NAS every day as of 2020 [5]. This data highlights the urgent need for awareness, prevention, and treatment measures to address the impact of maternal opioid use on newborns.

State Variances in NAS Rates

The occurrence of NAS varies significantly across states, reflecting differences in opioid use and healthcare practices. In 2020, the rates of NAS diagnoses per 1,000 newborn hospital stays ranged from one in Hawaii to 43 in West Virginia [5]. These disparities demonstrate the importance of understanding regional factors and implementing targeted interventions to address the specific challenges faced by each state.

It is crucial for healthcare providers, policymakers, and communities to work together to address the rising cases of NAS and the state variances in NAS rates. By focusing on prevention, early identification, and comprehensive treatment approaches, we can strive to reduce the impact of maternal opioid use on newborns and provide better outcomes for both mothers and their babies.

Support and Initiatives

Addressing the growing concern of babies being born addicted to opioids requires a multifaceted approach involving various support programs and initiatives. Hospital programs dedicated to Neonatal Abstinence Syndrome (NAS) and federal and state initiatives play a crucial role in providing care and support for affected infants and their families.

Hospital Programs for NAS

In response to the increasing number of infants born with NAS, specialized hospital programs have emerged to provide comprehensive care. One such program is Lily's Place, an inpatient facility in West Virginia. Lily's Place was specifically created to offer therapeutic and pharmacological care to babies with NAS, ensuring a supportive transition before they return home. This pioneering facility became the first approved by the Centers for Medicare & Medicaid Services for a new NAS services payment model [6].

Another notable initiative is the launch of a new clinic at Massachusetts General Hospital (MGH). This clinic, which started in April 2018, aims to provide postpartum support for mothers involved in opioid use. By offering a comprehensive range of services, including addiction medicine, obstetrics care, adult and pediatric care, psychiatry, social work, and recovery coaching, the clinic addresses the diverse needs of both the mother and the baby [6].

Federal and State Initiatives

Recognizing the critical need to address the issue of neonatal abstinence syndrome, federal and state initiatives have been implemented to safeguard the well-being of affected infants. Federal law now requires states to take steps to protect babies born dependent on opioids. These provisions call on state child protection authorities to assess all cases of drug-dependent newborns and develop a plan of safe care. The aim is to ensure that these vulnerable infants receive the necessary support and services [7].

While federal law has established guidelines, the implementation and adherence to these provisions vary among states. Unfortunately, many states have yet to fully embrace these federal initiatives, putting thousands of newborns at risk [7]. It is crucial for states to prioritize the well-being of these infants and work towards fully implementing the necessary measures outlined in federal law.

Despite the urgency of the issue, it is important to note that no state has ever lost federal funding for failing to meet the provisions of the law. This highlights the need for increased awareness and commitment to prioritize the care and support of newborns affected by opioid addiction.

By establishing hospital programs dedicated to NAS and implementing federal and state initiatives, communities are taking steps to address the growing crisis of babies born addicted to opioids. These measures aim to provide the necessary support, care, and resources for both the infants and their families, ensuring a brighter and healthier future for these vulnerable individuals.

Addressing Maternal Opioid Use

To effectively address the issue of maternal opioid use and mitigate its impact on neonatal abstinence syndrome (NAS), certain measures need to be taken during prenatal care and beyond. Two key approaches in addressing maternal opioid use include prenatal care and screening, as well as a multidisciplinary care approach.

Prenatal Care and Screening

Early identification and intervention are crucial in addressing maternal opioid use. Integrating prenatal care and screening practices can help identify pregnant individuals who are using opioids and provide appropriate support and treatment. Universal screening, as recommended by the American College of Obstetricians and Gynecologists (ACOG), ensures that all pregnant individuals are screened for opioid use and opioid use disorder.

Screening methods may include self-reporting, urine or blood tests, or questionnaires designed to assess opioid use and related issues. By implementing universal screening protocols, healthcare providers can identify individuals who may require specialized care and support for opioid use disorder during pregnancy. This early identification allows for timely interventions and improved maternal and infant outcomes.

Multidisciplinary Care Approach

A multidisciplinary care approach is essential in providing comprehensive and holistic care to pregnant individuals with opioid use disorder. This approach involves collaboration among various healthcare providers, including obstetric care providers, addiction medicine specialists, mental health professionals, and social service providers.

By combining the expertise of different professionals, this approach aims to address the complex needs of pregnant individuals with opioid use disorder. It involves coordinated efforts to ensure that individuals receive appropriate medical care, addiction treatment, mental health support, and social services. The goal is to optimize care for both the mother and the baby, promoting healthier outcomes.

Furthermore, the collaborative nature of the multidisciplinary care approach enables healthcare providers to address co-occurring mental health conditions, such as depression and anxiety, that commonly accompany opioid use disorder in pregnancy. It also allows for the identification and management of other substance use issues and social service needs that pregnant individuals may face.

By implementing a multidisciplinary care approach, healthcare providers can provide comprehensive support and treatment to pregnant individuals with opioid use disorder, ensuring that they receive the necessary interventions to improve their overall well-being and the health of their infants.

Addressing maternal opioid use requires a multifaceted approach that includes early prenatal care and screening, as well as a collaborative and coordinated multidisciplinary care approach. These strategies aim to identify and provide appropriate care and support to pregnant individuals affected by opioid use, ultimately improving outcomes for both the mother and the baby.


[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9676971/

[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261830/

[3]: https://www.cdc.gov/pregnancy/opioids/treatment.html

[4]: https://www.marchofdimes.org/find-support/topics/planning-baby/neonatal-abstinence-syndrome-nas

[5]: https://www.cdc.gov/pregnancy/opioids/data.html

[6]: https://www.aamc.org/news/caring-babies-opioid-withdrawal

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