What are newborn addicts?

Causes

Newborns are born with addictions to substances of abuse when their mothers choose to use drugs while pregnant—either as a conscious choice (such as to drink alcohol or smoke a cigarette) or as a result of chronic addiction. Abusive substances include prescription opioids, alcohol, tobacco, and illicit street drugs such as cocaine and heroin.

Maternal drug use affects the fetus during every stage of pregnancy. Infant liver function is underdeveloped in the womb, so substances are not removed from the fetus’s body efficiently; thus, the fetus, more so than the pregnant woman, is exposed to even more prolonged, damaging drug amounts.

Risk Factors

Even limited maternal drug use can lead to addiction in the fetus, because drug effects are quite variable. However, the highest-risk infants are those with mothers who have an extended history of abuse or who have had children born with addiction.

Symptoms

Symptoms common to newborn addicts include premature birth, low birth weight, and congenital defects, such as heart problems. Newborn addicts frequently experience trembling and excessive crying; they startle at touches, sounds, or lights and are easily unsettled. Often, these infants cannot be comforted and become withdrawn.

Some symptoms are drug specific, such as cocaine-induced jitters and irritation or marijuana- or alcohol-related growth delays after birth. Infants diagnosed with fetal alcohol syndrome display facial defects in the eyes and nasal groove, mental disabilities, and poor coordination and attention.

Long-term drug effects can be subtle, such as adulthood attention or sleep problems in newborns addicted to marijuana. Long-term effects also can be pronounced, such as neurologic deficits and hyperactivity in teenagers who were chronically exposed to alcohol before birth.

Screening and Diagnosis

Addiction in a newborn can be anticipated by maternal use patterns; conversely, diagnosis can be challenging if mothers are uncooperative or hide their addictions to avoid losing their newborns to social service programs. To complicate the diagnostic workup, symptoms associated with particular drugs of abuse are difficult to clarify because many newborns have been exposed to multiple substances.

Diagnosis of alcohol syndrome in a newborn addict is comparatively easy, because of the classic triad of symptoms. Suspected toxicities can be verified with blood tests that screen for positive drug concentrations. General indications that support a diagnosis of newborn addiction include premature birth, clinically low birth weight, and small head circumference. Although these symptoms occur frequently with abusive drugs, they are not specific to addiction problems.

Withdrawal symptoms definitively support an addiction diagnosis but develop after days without a drug source, not immediately after birth. A suspected newborn addict should therefore remain in the hospital for a minimum of four or five days under close observation for withdrawal onset.

Treatment and Therapy

Treatment of the newborn addict rarely begins before birth, even when the mother’s substance abuse history is confirmed. Few health professionals are knowledgeable specialists in addiction care during pregnancy, and treatment entails risks of severe fetal consequences from withdrawal.

If a physician considers treatment, methadone
administered to the mother can prevent extreme in utero complications and ease treatment of the newborn addict after birth. However, methadone use causes its own side effects after birth and requires careful weaning in newborns.

Treatment of the newborn focuses on acute and chronic needs. Immediate care includes support for vital functions to maintain adequate blood flow, respiration, and body temperature. Addicted babies often require isolated, reduced-stimuli settings to foster adjustment to life without drugs. Opioid addiction often requires slow weaning of dosages to minimize withdrawal. Pharmacologic care for the addicted newborn has little research or standards; treatment guidelines by the American Academy of Pediatrics focus on opioid withdrawal concerns specifically.

Withdrawal medications may be warranted, especially for infants addicted to opioids. Methadone is a traditional withdrawal treatment with mixed activity at opioid receptors. Clonazepam may be administered to slow the metabolism of methadone. Buprenorphine, a weak opioid agonist, has fewer supporting studies for use in newborn addicts but is associated with generally minimal withdrawal symptoms.

Many growing newborn addicts require treatment for lack of early pediatric care, for poor nutrition during neonatal development, and for exposure to sexually transmitted diseases. Stable environments are essential to minimize long-term addiction effects. The full effects of long-term consequences of newborn addiction are uncertain. Even infants who receive early detoxification can develop permanent disabilities from drug use. Cognitive learning disabilities, physical deformities, and emotional or behavioral disorders have all been connected with maternal substance abuse and newborn drug exposure.

Prevention

According to the Centers for Disease Control and Prevention (CDC), addiction in newborns is becoming epidemic in the United States, which has paralleled with the increased prevalence of opioid abuse, especially prescription pain-killers. According to the Association of State and Territorial Health Officials, the incidence of neonatal abstinence syndrome (NAS), or the problems a newborn experiences when going through withdrawal after drug exposure in the womb, had risen to 3.39 per 1,000 US hospital births in 2009. Following a study of three hospitals in Florida, which revealed that the state had seen a tenfold increase in the incidences of newborns struggling with NAS since 1995, the CDC continued to emphasize the importance of this steadily growing concern in a 2015 report. The study also found that the incidence of NAS had tripled nationally. However, state tracking of diagnoses is sporadic, so the true number of affected children is unknown. The best prevention is maternal avoidance of abusive substances; often, no amount of a drug is safe for developing infants. Prevention of drug use during pregnancy hinges on public awareness, both universally through public service announcements and selectively for women who have histories conducive to drug abuse.

Bibliography

Association of State and Territorial Health Officials. Neonatal Abstinence Syndrome: How States Can Help Advance the Knowledge Base for Primary Prevention and Best Practices of Care. Arlington: Assn. of State and Territorial Health Officials, 2014. PDF file.

Bernstein, Lenny. "When Life Begins in Rehab: A Baby Heals after a Mother's Heroin Addiction." Washington Post. Washington Post, 12 Aug. 2015. Web. 27 Oct. 2015.

Guidelines for Identifying Substance-Exposed Newborns. Phoenix: Arizona Dept. of Economic Security, 2005. PDF file.

Hankin, Janet R. Fetal Alcohol Syndrome Prevention Research. National Institute on Alcohol Abuse and Alcoholism. US Dept. of Health and Human Services, Aug. 2002. Web. 27 Oct. 2015.

Hudak, Mark L., et al. “Neonatal Drug Withdrawal.” Pediatrics 129.2 (2012): 540–60. Print.

Lind, Jennifer N., et al. "Infant and Maternal Characteristics in Neonatal Abstinence Syndrome—Selected Hospitals in Florida, 2010–2011." Centers for Disease Control and Prevention. CDC, 6 Mar. 2015. Web. 27 Oct. 2015.

Rayburn, William, F. “Maternal and Fetal Effects from Substance Use.” Clinical Perinatology 34 (2007): 559–71. Print.