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Dependent, Not Addicted: Infants in the Opioid Epidemic

Crying Newborn

"Born Addicted," scream the headlines about babies born to mothers using opioids during pregnancy. There are a growing number of newborns being seen with what is known as neonatal abstinence syndrome (NAS), a set of physical and behavioral symptoms in those born to mothers who took addictive prescription or illicit drugs during pregnancy. But while these babies are born to mothers who are addicts, Karen Buchi MD, chief of the Division of General Pediatrics for University of Utah Health says, the infants should not be labelled as such.

"Addiction is the maladaptive behavior that surrounds dependency. Babies are NOT born addicted," she says. "Dependency means that your body is dependent on the opioid and you will experience withdrawal when the opioid isn't around anymore. They may be born dependent on opioids and need to be medically-managed while their bodies adapt to the lack of opioids once the cord is cut."

According to the U.S. Centers for Disease Control and Prevention, the number of babies born with neonatal abstinence syndrome tripled in the period between 1999 and 2013. The symptoms of NAS are similar to those of opioid withdrawal in adults. The infants may be irritable and jittery and have muscle contractions. They may also be vomiting and have diarrhea. "All of these symptoms can greatly interfere with the newborn's ability to feed and sleep," says Buchi.

Babies born with NAS need to receive special treatment after birth to help them deal with withdrawal symptoms. However, there currently is not an evidence-based best practice for such treatment. So Buchi—along with colleagues Camille Fung, MD, a UUH neonatologist; and Julie Shakib, DO, medical director of the University Hospital Intermediate Care Nursery—has instituted an NAS care process model at University Hospital to monitor and improve quality care for newborns with NAS.

Infants with NAS are carefully monitored by nursing staff for signs of withdrawal. If symptoms reach a certain level, the infant may be given medication, like morphine. Then, as the baby's condition improves, he or she is slowly weaned off the drugs. "Both the administering and weaning of drugs are guided under a care process model," says Buchi. "This model was developed to improve the quality of the care in the management of newborns with NAS."

An extended stay in the nursery is the short-term impact of NAS on infants. There could be long-term impacts as well. Current research finds these children are put at risk for developmental and behavioral problems. Whether those problems develop depends not only on the child, but their addicted parent as well. "It depends on the quality of the post-natal environment in which the child is raised," says Buchi. "That is why treatment of the mother's addiction is so important."

There are instances when mothers need to take opioids during pregnancy—for instance, after surgery or injury. However, prolonged use is a real concern. "The longer a pregnant woman remains on opioids, the higher the risk that her newborn will develop neonatal abstinence syndrome," says Buchi.