Central PA Medicine Fall 2017 - 31

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he impact of Opioid Addiction
continues to grow nationally and
here in Pennsylvania. Use and abuse
of drugs by expectant mothers
has very harmful effects on the newly born
infants also. Infants who are born to mothers
who have used narcotics or other drugs suffer
from a condition called Neonatal Abstinence
Syndrome (NAS). NAS results from the abrupt
discontinuation of chronic fetal exposure to
substances that were used or abused by the
mother during pregnancy. It is a generalized
multisystem disorder, which predominantly
involves the central and autonomic nervous
systems, as well as the gastrointestinal tract
and other systems. Neonatal withdrawal due to
prolonged maternal opioid use may be severe
and intense. Although NAS is rarely fatal, it
can cause significant illness and often results
in prolonged hospital stays, mostly in NICU.

According to a PA state analysis,
Hospitals in Pennsylvania have seen an
alarming increase in rates of babies born
addicted to opioids over the last 15 years,
a reflection of the national epidemic of
pain pill and heroin abuse.
per 1000 live births in 2009, and diagnoses of
NAS correspondingly increased from 1.2 to
3.4 per 1000 live births. The Substance Abuse
Mental Health Services Administration reported
that 1.1% of pregnant women abused opioids
(0.9% used opioid pain relievers and 0.2% used
heroin) in 2011.

bonding and breast feeding can also help
mitigate the severity of NAS.

As we look to control this opioid epidemic and
its effect on newborns, our focus should be on
prevention in the first place. The centerpiece of
decreasing incidence of NAS in the most fragile
population, is decreasing opioid and other drug
Though opium use dates back to the very
According to a PA state analysis, hospitals in use overall and especially in expectant mothers.
early civilizations, morphine was reported to be Pennsylvania have seen an alarming increase in This involves decreasing both prescription drug
first isolated in 1804 and heroin was reportedly rates of babies born addicted to opioids over use and also controlling illicit drug use. There
synthesized in 1874. After their commercial pro- the last 15 years, a reflection of the national has been a lot of attention to the opioid crisis
duction was started, addiction to these opioids epidemic of pain pill and heroin abuse.
recently. PA Governor Tim Wolf has also taken
became more common in adults. In neonates,
the lead in confronting the heroin-opioid epithe first case was reported in 1875, when a child
The Pennsylvania Health Care Cost Contain- demic and recognizing the problem as a disease.
manifested signs of opioid withdrawal at birth, ment Council used hospital records from 2000 The governor mentioned in a report that there
and the infant was diagnosed with congenital through 2015 to analyze how often mothers were 2,500 fatal drug overdoses in 2014 and
morphinism. Congenital morphinism was later and newborns were hospitalized because of 2,500 in 2015. To help combat the problem,
renamed as abstinence syndrome in neonates. addiction issues. In 2015, 2,691 newborns were dozens of new treatment centers around the
Methadone was introduced as a treatment of hospitalized in Pennsylvania for substance-related state have been opened, thanks, in part, to a
opioid addiction in 1964. But soon methadone problems, or almost 2 percent of the 138,000 nearly $5.5 million federal grant. In a recent
use itself was found to be associated with with- infant hospitalizations. The rate increased by report put out by the U.S. Surgeon General,
drawal in neonates. Later, buprenorphine (1996) 250 percent from 2000 to 2015, when nearly he writes, "We also need a cultural shift in how
was approved as an alternative to methadone 20 out of every 1,000 newborn hospital stays we think about addiction. For far too long, too
but use of buprenorphine during pregnancy were because of drug use by mothers. Most many in our country have viewed addiction as
has also resulted in NAS. Neonatal withdrawal often (82 percent of the time) the babies were a moral failing. We must help everyone see that
secondary to the maternal use of prescription born addicted to the opioids their mothers took. addiction is not a character flaw - it is a chronic
pain medications is the latest additional etiology
illness that we must approach with the same
in the history of neonatal withdrawal.
Treatment of NAS in infants is often long skill and compassion with which we approach
and involves using drugs like morphine or heart disease, diabetes, and cancer."
Nationwide, an infant is born with NAS every benzodiazepines for control of signs and
25 minutes. The incidence of NAS in infants symptoms. Medications are started to control
We physicians need to take a leading role
has been increasing nationally all over the U.S. the initial signs and symptoms and slowly in combating this epidemic. It involves
Increases in the incidence of NAS have been weaned off as infants' symptoms subside. The high involvement from care providers and
reported uniformly across community hospitals, process is extensive and sometimes can take involves providing counselling/education
teaching hospitals, and children's hospitals. NAS a few weeks to months. Non Pharmacologic when we suspect opioid/drug addiction,
has affected all communities and all ethnicities. measures like a quiet environment, dim guiding patients to the right treatment path
In a recent national study, maternal opioid use lighting, and soft music can also help decrease and limiting opioid prescription use when
was shown to have increased from 1.2 mothers the severity of NAS. Recent literature shows addiction is suspected.
per 1000 live births in 2000 to 5.6 mothers that more parental involvement, skin to skin
Central PA Medicine Fall 2017 31

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