May 1, 2012
Infants Suffering From Opiate Addiction Withdrawal On The Rise
Opiate withdrawal among infants increased three-fold between 2000 and 2009 due to prescription painkiller abuse among mothers-to-be, according to a first-of-its-kind study in the United States.
The research, published in the Journal of the American Medical Association, also found that the number of women testing positive for illegal or legal opiates increased fivefold in the same period.
Neonatal abstinence syndrome (NAS), a withdrawal syndrome of infants, typically caused by administration of drugs, is a common occurrence in the medical sense of the term. But illicit drug abuse (specifically opiates) during pregnancy is associated with a much more significant increased risk of adverse NAS outcomes such as low birth weight and mortality, wrote the authors of the study.
Increased irritability, hypertonia (increased muscle tone), tremors, feeding intolerance, seizures, and respiratory distress are some of the more acute signs and symptoms of NAS. Withdrawal symptoms associated with NAS have been described in 60 to 80 percent of newborns exposed to heroin and methadone in utero.
Based on records obtained from more than 4,000 US hospitals, the researchers examined patterns in the national incidence of NAS and maternal opiate use at the time of delivery and to characterize trends in national health care costs associated with NAS between 2000 and 2009. They used the Kids' Inpatient Database (KID) to identify newborns with NAS by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code.
The Nationwide Inpatient Sample (NIS) was used to identify mothers using diagnosis-related groups for vaginal and cesarean deliveries. Clinical conditions were identified using ICD-9-CM diagnosis codes. NAS and maternal opiate use were described as an annual frequency per 1,000 hospital births. All hospital charges were adjusted for inflation to 2009 costs.
What the researchers discovered was alarming. Between the 10-year study period, the rate of newborns diagnosed with NAS increased from 1.2 to 3.39 per 1,000 hospital births a year. Also during this time period, opiate use in pregnant women increased from 1.19 to 5.63 per 1,000 hospital births per year.
“Compared with all other hospital births, newborns with NAS were significantly more likely to have respiratory diagnoses (30.9 percent), to have low birth weight (19.1 percent), have feeding difficulties (18.1 percent), and have seizures (2.3 percent). Newborns with NAS were also more likely to be covered by Medicaid (78.1 percent) and reside in zip codes within the lowest income quartile (36.3 percent),” wrote the authors.
Medical costs for dealing with NAS rose significantly, with the average costs growing from $39,400 in 2000, to $53,400 in 2009, a 35 percent increase after adjusting for inflation. Hospital length of stay for newborns diagnosed with NAS averaged 16 days, and remained relatively unchanged during the study period. During the ten-year study period, total charges for NAS have increased from $190 million to $720 million, after inflation adjustments.
Despite rising health costs due to NAS, the country is obligated to help these newborns, as they “have made no choices around drug abuse and addiction” and are “the most vulnerable and the most blameless” members of society, said Marie Hayes, a psychology professor at the University of Maine, who co-wrote an accompanying editorial with the study, but was not involved in the study.
Unlike the 80s and 90s, when cases of newborns addicted to crack cocaine were on the rise, many newborns today are hooked on powerful prescription painkillers, such as Vicodin and OxyContin, said Patrick.
“The prevalence of drug use among pregnant women hasn´t changed since the early 2000s, but the types of drugs that women are using” are changing, Andreea Creanga, a researcher with the Centers for Disease Control and Prevention (CDC), told Liz Szabo of USA Today. Creanga noted that about 4.5 percent of pregnant women use illegal drugs.
The CDC identifies prescription-painkiller abuse as a major health threat, noting that these drugs now cause more overdose deaths than heroin and cocaine combined. The death rate from overdoses is three times higher in 2007 (12 in 100,000) than in 1991, according to a recently released CDC report. Most of that increase came from prescription drugs, the report noted.
Many mothers didn´t know that prescription painkillers were harmful to their unborn children, perhaps because the drugs are technically legal, Mark Hudak, a spokesman for the American Academy of Pediatrics (AAP), told Szabo. Other mothers are addicted when they become pregnant and are unable to quit.
Sometimes, babies are exposed to multiple drugs while in the womb. These can include tobacco, alcohol, marijuana, and antidepressants, said Howard Heiman, associate chief of the neonatal intensive care unit at Cohen Children's Medical Center of New York. Researchers need to find better ways to treat drug-addicted mothers and to identify and treat addicted babies as early as possible.
“In conclusion, newborns with NAS experience longer, often medically complex and costly initial hospitalizations. The increasing incidence of NAS and its related health care expenditures call for increased public health measures to reduce antenatal exposure to opiates across the United States,” wrote the authors.
The team´s study was published early and will be presented at the annual meeting of the Pediatric Academic Societies in Boston.
The study was supported by a grant from the Robert Wood Johnson Foundation Clinical Scholars Program.
According to background information in the study, 16.2 percent of pregnant teens and 7.4 percent of pregnant women aged 18 to 25 use illicit drugs.