The National Institute on Drug Abuse states that the number of newborns with neonatal abstinence syndrome or neonatal opioid withdrawal syndrome NAS/NOWS has increased by more than five-fold since 2004. An estimated 32,000 infants with NAS/NOWS were born between 2004 and 2014.
Prescription Drug Abuse Epidemic
Because prescription drug abuse has increased across the board nationwide, many of those who are addicted to opioid painkillers include pregnant women. Consequently, there has been a corresponding increase in the number of addicted newborns who experience drug withdrawal symptoms. Some babies are born addicted because their mothers are receiving pharmacological treatment for drug addiction with methadone or buprenorphine. Other mothers are actively addicted to heroin, cocaine, or other illegal drugs. The Centers for Disease Control reports that non-medical use of prescription opioids has reached epidemic proportions in the United States in the last decade.
New Guidelines Published
Some infants who were exposed to drugs in the womb experience no withdrawal symptoms at all, the AAP report said; some have only mild clinical signs of withdrawal, but some have much more severe withdrawals, which in extreme cases can be fatal. To make sure these addicted newborns are identified and given appropriate treatment, the AAP published updated guidelines in the journal Pediatrics. The guidelines include “evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.”
Symptoms of Infant Drug Withdrawal
Infant drug withdrawal symptoms can include:
IrritabilitySeizuresShrill cryingTremorsVomiting
Long-term symptoms can include birth defects, impaired growth, and behavior problems.
Range of Treatment Options
Treatment options suggested by the guidelines range from simply making the infant more comfortable—minimizing exposure to light and sound, or swaddling and rocking—to using medication to reduce moderate to severe withdrawal symptoms. According to the AAP, doctors have treated drug withdrawal symptoms in newborns with a variety of drug preparations, including opioids (tincture of opium, neonatal morphine solution, methadone, and paregoric), barbiturates (phenobarbital), benzodiazepines (diazepam, lorazepam), clonidine, and phenothiazines (chlorpromazine).
Why Pharmacological Treatment Is Not Always Best
However, the guidelines caution that pharmacological treatment is not always the best option because it will prolong the baby’s drug exposure and lengthen the hospital stay, which could possibly harm maternal-infant bonding. Use of medication to treat the infant’s withdrawal symptoms might also reinforce the mother’s tendency to rely on drugs to treat the baby’s discomfort or annoying behavior, the AAP warns. Mark Hudak, M.D., the lead author of the expanded guidelines, said the problem facing pediatricians is finding the right amount of medication to relieve the infants’ symptoms and pain without giving them so much medication that they become addicted. The complete guidelines are available online in PDF format.
