The rate of babies being born with neonatal abstinence syndrome in Rhode Island has doubled between 2006 and 2013 according to Rhode Island Kids Count’s 2015 Factbook. Babies are born with NAS when exposed to opioids, such as vicodin, oxycontin and heroin, in the womb.
“For a state our size, the fact that 76 babies were born (in 2013) with opioid exposure is an alarming statistic,” said Elizabeth Burke Bryant, executive director of R.I. Kids Count. “It’s on everyone’s radar screen as a number that we want to turn around and improve.”
Babies with NAS undergo physical withdrawal from opioids where “everything kind of revs up,” said Marcia VanVleet MPH’10, assistant professor of pediatrics and director of the Newborn Nursery at Women and Infants Hospital, adding that these symptoms include high fever, diarrhea, rapid breathing and irritability.
The newborns “miss the opioids they had been exposed to in utero,” VanVleet said, adding that symptoms typically appear between three to five days after birth, depending on the drug type and last dosage taken.
While withdrawal in babies is similar to adults easing off drug use, babies are affected more because of their smaller stature, VanVleet said. Babies can become dehydrated through vomiting and diarrhea and also experience seizures — symptoms adults do not usually exhibit — she added.
This increase may come as a result of the fact that more women of reproductive age are becoming addicted to opioids, said Lynn Hess ’99, clinical assistant professor of psychiatry and human behavior. The increase in addiction is due to a “historically enormous increase in the number of prescription drugs that are being prescribed by doctors,” she added.
Patients can start using opioids for pain relief, but then their body becomes physically dependent on the substance, Hess said, adding that a patient might find that the opioid “feels good, helps them forget their problems (and) helps them become more productive.”
But pregnant women addicted to opioids are not recommended to stop opioid use while pregnant because the “risk of relapse is very high,” Hess said. When opioid addicts stop using, they develop flu-like symptoms, such as diarrhea, vomiting and tremors, she added. When pregnant addicts relapse, finding opioids becomes a priority, even over taking care of their babies. Instead of asking pregnant women addicted to opioids to stop using during pregnancy, physicians prescribe either methadone and buprenorphine — one of which is an opioid, and the other acts like an opioid, respectively. Both of these medications also cause NAS in babies.
Treatment is administered early on in a baby’s life to get drugs out of his or her system, Bryant said.
Babies exposed to opioids are treated with morphine, methadone and phenobarbital, VanVleet said.
“These trends are the same that people are seeing nationally, so I’m not surprised,” VanVleet said, adding that the number of babies born to mothers taking prescription medications, morphine and methadone have all increased.
A possible solution is ensuring access to high-quality prenatal care, Bryant said, adding that “it is so much wiser to invest in prevention than have to intervene when these bad outcomes happen.”
Ultimately better communication between providers and patients is also part of the solution, VanVleet said.
