The opioid crisis has resulted in a rise of infants born with opioid withdrawal symptoms.
Newborns exposed to opioids during pregnancy are more likely to be medically treated with morphine to ease painful withdrawal symptoms, but a new study suggests that may no longer be the best practice.
From 2004 to 2014, an estimated 32,000 newborns were born with neonatal abstinence syndrome (NAS), a result of their mothers having an addiction to prescribed or illegal opioids during pregnancy, according to the latest figures provided by the National Institute on Drug Abuse.
The agency reported that the surge represents a fivefold increase since 2004, and that every 15 minutes, a baby is born with opioid withdrawal symptoms.
Even with the rise of babies born with NAS, medical treatment for them has changed very little in more than a decade, according to the authors of a new study published this month in JAMA Pediatrics.
The researchers wanted to look at the evidence of which medications and treatments were best for infants with NAS.
After studying the results of 18 different, small, randomized clinical trials where newborns got treatment for NAS, researchers found evidence that certain drugs were better than others to help the infants.
The researchers estimate 50 to 80 percent of infants with NAS are treated pharmacologically.
They found the drugs buprenorphine and methadone were superior to morphine in treating newborns with NAS, as length of treatment and time in the hospital were shorter.
Currently, morphine has been the tried-and-true standard of care for newborns to calm jitteriness and diarrhea. But it may result in longer hospital stays, costing an average $93,400 per infant, researchers noted.
Instead, the findings point to alternative medications as being preferable to treating infants with NAS. The researchers did caution that since neither methadone nor buprenorphine have been compared head-to-head in random clinical trials, it remains unknown if one drug is superior to the other.
They also said despite their findings, there are still too many missing pieces of information to make a definitive recommendation, including a lack of longer, more sophisticated clinical trials. In addition, not enough hospitals use methadone or buprenorphine.
Also, the long-term effects of those drugs are still unknown, says study co-author Marsha Campbell-Yeo, PhD, associate professor and clinician scientist at the school of nursing and departments of pediatrics, psychology, and neuroscience at Dalhousie University in Nova Scotia.
“There hasn’t really been large work done in this area. This tells us this problem hasn’t really been studied,” Campbell-Yeo said.
“It does also tell us there really is an urgent need for government funding for long-term work,” she added, as well as an overall consensus among healthcare providers to reduce the need for pharmacological treatment.
For its part, the federal government has taken note of the need to expand access to care for mothers and their newborns, particularly in rural areas.
The opioid crisis has continued to worsen across much of the country, resulting in rising numbers of fatal overdoses and infants born with NAS. The Centers for Disease Control and Prevention (CDC) estimates more than 47,000 people died from overdoses that involved opioids in 2017.
There’s been a 300 percent increase in the incidence of NAS from 1999 to 2013, reports the CDC.
In October of last year, the Centers for Medicare & Medicaid Services announced the launch of the Maternal Opioid Misuse (MOM) program. The agency plans to partner with several states over the next five years to offer services to mothers with substance use disorders and newborns dependent on drugs.
Some of those services include better access to maternity care as well as mental health services. Federal officials say Medicaid pays the largest portion of hospital charges for maternal substance use as well as a majority of the $1.5 billion annual cost of treating NAS.
In the meantime, some hospitals are already moving away from pharmacological treatments, says Dr. Richard Polin, director of the division of neonatology at New York-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Irving Medical Center. Polin says his facility sees a fair number of babies born with NAS.
“We try everything we can that is nonpharmacological,” Polin said, but he admits the lack of research means the best way to treat NAS is still unknown.
“There are not enough large clinical trials to say what is the best treatment for the baby,” he said. “The science is just beginning to be developed to best identify new methods of treatment to treat these babies.”
In some states, such as Florida, hospitals are collaborating to develop a consistent set of best practices, says Dr. Saima Aftab, Pediatric Specialists of America chief for the section of neonatology and perinatal medicine and medical director of the fetal care program at Nicklaus Children’s Hospital in Miami, Florida.
She says some centers are focused on improving screening methods for withdrawal and easing an infant’s symptoms by encouraging mothers to be present in the neonatal intensive care unit (NICU) more often when their babies are feeding and sleeping, and to be there to console them when there are signs of withdrawal.
“Not all signs of withdrawal need to be treated with morphine,” Aftab said. “Historically, we would really think the first line would be treated with medicines.”
There’s also an ongoing emphasis on training healthcare providers to reduce bias and judgement of mothers whose babies are born with NAS, which can also be an important step in reducing the use of morphine and other drugs, Aftab adds.
“A lot of these moms, their stories just break your heart,” she said of those who have been homeless or escaped domestic violence.
Many of them feel guilt when they see their babies experiencing withdrawal. Aftab says by including moms in their babies’ care earlier and more often, both mother and baby may heal.
Aftab adds she and her colleagues in neonatal care know there’s no “one-size-fits-all approach.”
But she says the recent study opens up more discussion and may pave the way for more research on how to improve the care of mothers and their newborns with NAS.
“There’s been a transition of understanding the importance of mom being present,” Aftab said. “We’re actually on the right path.”