What is Perinatal Drug Abuse and Neonatal Drug Withdrawal?

Over the past few decades, there has been a significant rise in drug abuse and addiction, specifically with opioids. This rise also includes women who are at an age where they can bear children and those who are already pregnant. Using drugs during pregnancy can pose a severe health threat to both the mother and the newborn baby. Babies who are exposed to drugs while in the womb can show signs of drug withdrawal early in their lives. This withdrawal condition is referred to as neonatal abstinence syndrome (NAS). While NAS is not deadly, it can cause serious illnesses and may lead to an extended hospital stay.

What Causes Perinatal Drug Abuse and Neonatal Drug Withdrawal?

Opioids are the drugs most often misused, and they can cause serious health problems in newborn babies. It’s also very common for people to misuse more than one type of drug. Other drugs that are often used improperly include nicotine, cocaine, heroin, benzodiazepines (a type of medication used to treat anxiety and insomnia), amphetamines (stimulants), and selective serotonin reuptake inhibitors (antidepressants).

Risk Factors and Frequency for Perinatal Drug Abuse and Neonatal Drug Withdrawal

In 2013, about 5.4% of pregnant women between the ages of 15 and 44 used illegal drugs. The rates were even higher for women between 18 and 25. Drug use during pregnancy is an issue that affects women from all backgrounds, regardless of factors like race or economic status. However, it’s more common in young, unmarried women and women with a lower level of education.

In the past 20 years, opioid use has increased dramatically, almost five times more than before. This has led to a rise in infants born with neonatal abstinence syndrome – their rate has gone up from 1.2 to 3.4 per 1000 live births every year. As a result, hospital costs have significantly increased due to the extensive care required for both the addicted mothers and their newborns who need to stay hospitalized for weeks to manage their withdrawal symptoms.

Signs and Symptoms of Perinatal Drug Abuse and Neonatal Drug Withdrawal

Newborn babies who show withdrawal symptoms usually have a mother who used drugs before and during pregnancy. When these symptoms start to appear depends on the last dose of drugs the mother took and how long it takes for the particular drug to leave the body. Babies exposed to short-acting drugs like heroin can show signs of withdrawal within 24 hours. But if it’s a long-acting drug like methadone or buprenorphine, it may take 1 to 3 days for symptoms to appear. Sometimes, withdrawal symptoms might not show up until the baby is five days old or even later. That’s why newborns who have been exposed to opioids need to be watched in the hospital for at least 5 to 7 days, with plans in place for continuous care post-discharge.

The common signs of a baby going through withdrawal are:

High-pitched, excessive crying
Tremors (shakes) and restlessness
Difficulty sleeping
Increased muscle tone
An exaggerated startle reflex
Difficulties with feeding, such as vomiting, poor coordination, and lack of weight gain
Diarrhea and a sore bottom from diaper rash
Sweating, sneezing, fever, patchy skin color changes, and unstable body temperature
Rapid breathing rate and heart rate
Seizures

The start time, type, and severity of withdrawal symptoms can vary widely from one baby to another. The reasons for this are not well-understood but could be caused by a mix of factors including:

Type and amount of drugs the mother used
Use of opioids and other drugs together
Maternal issues like nutrition, infections, and mental health conditions
Genetic factors
Premature birth or other health issues in the baby
Breastfeeding preferences
Environmental factors such as care-provider availability, noise, and light levels

Testing for Perinatal Drug Abuse and Neonatal Drug Withdrawal

To check if a mother has used drugs during her pregnancy, doctors typically look at her prenatal history and use urine drug tests. These tests can also be done on the newborn’s urine. Furthermore, doctors can test the newborn’s first feces, also known as meconium, for the presence of drugs.

There are even tests that can detect drugs from a newborn’s hair and the tissue from the umbilical cord. However, all these tests have their drawbacks. For example, urine tests might not detect drugs unless the baby was exposed to them very recently. Meconium tests can detect drugs over a longer period, but these tests take a lot of time and are typically only performed at specialized laboratories. Furthermore, the presence of drugs in meconium doesn’t necessarily mean recent use.

There may also be delays in obtaining meconium as it may not be passed for several days. Additionally, testing a newborn’s hair for drugs can be challenging due to traces of the drug being minimal and slow hair growth.

While these tests might have limited use in a clinical setting, they can still be valuable, especially when a newborn shows signs of drug withdrawal, but the mother denies using any substances.

Treatment Options for Perinatal Drug Abuse and Neonatal Drug Withdrawal

Treating newborns who are experiencing drug withdrawal, known as neonatal abstinence syndrome, requires a team approach that includes doctors, nurses, occupational and physical therapists, social workers, and child life specialists. It’s just as important to have a plan for after they leave the hospital as it is to care for them while they’re in it.

Hospitals should follow a standardized policy for treating these newborns. Following this approach has been shown to reduce their length of hospital stay.

Care during the hospital stay combines medical and non-medical interventions. Non-medical interventions aim to reduce the need for medication and are adjusted according to the individual baby’s behavior. These can include things like swaddling, rocking, reducing noise and light levels, offering small frequent feedings, providing nutritional support, and managing related issues like loose stools and skin irritation around the rectal area.

Mothers who are on stable medication regimes for drug dependence, such as methadone or suboxone, should be encouraged to breastfeed. Breastfeeding has the added benefits of increasing mother-baby bonding and encouraging the mother to participate in caring for the baby. Studies show breastfeeding can also lessen the need for treatment in babies exposed to opioids. However, breastfeeding is not advised for mothers who have recently used illegal drugs, did not receive adequate prenatal care, or have certain health conditions like HIV.

Medication is used to alleviate the symptoms of drug withdrawal in these babies. Although there’s no unanimous decision on the best opioid medicine for this situation, morphine is most commonly used. Methadone and buprenorphine are also common choices. If a baby is severely affected, a second medicine might be needed, with clonidine and phenobarbital being the usual selections. Phenobarbital is the first choice for withdrawal from non-opioid drugs.

Healthcare providers use various scoring systems to evaluate the baby’s symptoms and decide when to start, adjust, and stop opioid therapy. Monitoring for withdrawal signs begins at birth and continues every three to four hours throughout the hospital stay. Even though the Finnegan scoring system is most widely used, there’s no clear evidence that one system is better than another.

Once a baby has gradually withdrawn from the medication and remained stable for at least 24 hours, they are ready to leave the hospital. Some hospitals also allow babies to go home once they stop needing opioid medication and are managing on a prescribed second-line agent, which the pediatrician will slowly stop during follow-up visits.

When a person experiences symptoms related to drug withdrawal, it’s essential to understand that these symptoms can look a lot like those of other medical conditions. Here are a few conditions that need to be considered:

Sepsis: This severe infection can cause issues like fever and irritability.
Hypoxic ischemic encephalopathy: This condition, often caused by a lack of oxygen to the brain, can lead to abnormalities in body tone, irritability, and even seizures.
Metabolic disorders: These can include issues such as low calcium levels (hypocalcemia) and low blood sugar (hypoglycemia).
Endocrine disorders: For example, an overactive thyroid (hyperthyroidism) can cause symptoms like a variable body temperature, irritability, and diarrhea.

Therefore, it’s crucial that these possibilities are weighed against the likelihood of drug withdrawal when medical professionals are diagnosing the cause of these symptoms.