Opioid addictions drive increase in NAS babies in Louisiana

Opioid addictions drive increase in NAS babies in Louisiana

NEW ORLEANS, LA (WVUE) - A whimper and soft coos. From miniature beds, melodies of new life can be heard inside Children's Hospital.

But increasingly newborns in Louisiana are arriving with symptoms of a scary scourge.

"It's a public health problem - it's not just one mom and one baby," said Dr. Brian Barkemeyer, a neonatologist with LSU Health and Children's Hospital.

The problem is rooted in opiods, potent narcotics that include prescription pain pills and street drugs like heroin.

"When the babies have been exposed on a regular basis inside the womb quite often they come out and they're addicted at birth" said Barkemeyer.

The National institute on drug abuse says every 25 minutes a baby is born suffering from opioid withdrawal.

"Any hospital in the city you could go to on any given day, if there are babies being born there, there are babies being born who are addicted to these drugs," Barkemeyer said.

And the symptoms they exhibit outside of their mother's womb are well-known by medical professionals.

"Neonatal Abstinence Syndrome is a term used to describe the withdrawal symptoms that a baby experiences when withdrawing from medications like opiates, so a pregnant woman who's using a drug like an opiate - hydrocodone, fentanyl -  those highly addictive medications, those drugs pass from the mother's bloodstream to the baby that she is carrying," said Dr. Tina Stefanski, a regional medical director with the Louisiana Department of Health.

"Typically, they involve the baby being quite irritable with a very high-pitched, shrill cry, different from a normal baby's cry. They're very irritable, hard to feed, sometimes they eat very voraciously, but sometimes they can also be sloppy in how they eat, and be difficult to feed with frequent vomiting. They can have diarrhea, they can be very jittery, with lots of tremors," said Barkemeyer.

"So if a baby is exposed in-utero to a drug that a mother is taking, like an opiate, when that baby is born they can go through withdrawal," said Dr. Stefanski.

And what the newborns experience can be life-threatening.

"Not all babies exposed will have severe symptoms, so when the symptoms are severe enough, those babies have to be given medication to sort of ease the withdrawal symptoms. It's not just getting them to stop crying, but getting them to be able to feed, and to thrive and without that they really struggle...We usually use morphine in low-doses and we then gradually lower that dose over days to weeks until the baby's able to tolerate it," Barkemeyer stated.

The state tracks the problems in terms of Medicaid, a government-funded insurance program for the indigent and working poor.

"From the Medicaid side of things over a 10 year period of time, from 2003 to 2013, the number of babies born with the diagnosis of NAS has tripled…And I think this really parallels what we see in all parts of the population," said Dr. Stefanski.

The state has graphs and charts depicting the increase.

"This shows that the rate of babies born with the diagnosis of NAS in Louisiana is about 230 per 100,000 live births…The darker areas demonstrate those parishes with the highest rate of NAS diagnoses. So you can see the cluster around East Baton Rouge, West Baton Rouge, Orleans, Jefferson, St. Tammany, Tangipahoa," Dr. Stefanski said.

"The reported numbers are smaller than what's actually out there," said Dr. Arwen Podesta, M.D., a local psychiatrist and addiction specialist.

Dr. Podesta said opioids are a serious problem in St. Bernard Parish, too.

"I have an office over there and I just see the trends really increasing," Podesta stated.

"Women 21 to 35 have a higher rate of babies born with the diagnosis of NAS and then you can see the breakdown by race, you know, a slightly higher rate of NAS diagnosis in white women compared to African-Americans," Dr. Stefanski said.

"When we see an overdose death of a pain pill oftentimes in conjunction with other pills it's considered accidental poisoning and over the past five or so years we've seen a major increase in caucasian women so much so that Caucasian women have lost part of their life expectancy," said Dr. Podesta.

Podesta works with Drug Court, ACER and Odyssey House in New Orleans.  She said she has seen opioid-addicted school-age girls.

"At Odyssey House because we have an adolescent program, too, we've had probably two or three 15-year olds," stated Dr. Podesta.

For opioid-addicted expectant mothers, treatment protocols are carefully thought out and do not involve having them stop the drugs cold-turkey.

"The gold standard of treatment for opiate addiction during pregnancy is medicated assistance therapy, so where a physician will then prescribe a long-acting opiate that will stem the withdrawal symptoms, so it'll stem the craving, the mother won't feel craving for a drug," said Dr. Stefanski.

"Should the mom stop suddenly there's a high risk of miscarriage in that pregnancy," added Dr. Barkemeyer.

Even if a pregnant woman is getting appropriate medical treatment for her opioid addiction there are still risks for the child she's carrying.

"The risk of withdrawal for the baby though even when the mom is in a prescribed regimen still exists, but the safety for the mom and the baby is much better because we know what's going into her system," continued Dr. Barkemeyer.

Given the growing number of NAS cases the state's bottom line is greatly impacted.

"In 2013, the cost for the first year of life of these babies was over $15 million as compared to over $3 million in 2003," said Dr. Stefanski.

"On any given day in the metropolitan New Orleans there are probably double-digit babies in local hospitals that are being treated right now for withdrawal," said Dr. Barkemeyer.

And their hospital stays are elongated.

"These babies as they're being treated for NAS may have longer hospital stays, so longer stays in N-I-C-U, which can be very costly," said Barkemeyer.

The long-term consequences remain murky.

"Long-term consequences are very difficult because oftentimes women who using one drug maybe using other drugs …So it's very kind of difficult to parcel out what the effects are, long-term effects are from opiate exposure," said Dr. Stefanski.

"So a mom who might use only an opioid like oxycontin or like fentanyl or heroin, there's some exposures to that, that can be problematic, there's sometimes other substances also involved, tobacco, alcohol, cocaine, etc., so as a result picking out the damage from one drug is difficult and additionally they also have many other social factors, a lot of times these babies, the social setting that they're raised in may not be as optimal as we'd like it to be," said Dr. Barkemeyer.

The state has an informational toolkit to assist medical professionals.

"Women who do this don't intend to become pregnant and cause their babies to become addicted," said Dr. Barkemeyer.

Drug-addicted pregnant women are urged to be honest with their physicians.

"The whole disease of addiction is wrought with shame and guilt and regret, remorse and sometimes the mom that is newly pregnant that might actually be the straw that broke the camel's back or that propels her to get into treatment," said Dr. Podesta.

Witnessing what tiny newborns suffer within hours of being born can be hard for those caring for them in hospital nurseries.

"This is an avoidable problem and to see these babies suffer, to see what they're going through and to not know what their future's like, it hurts," Dr. Barkemeyer said.

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