A dramatic rise in newborns experiencing drug withdrawal after being exposed in the womb poses challenges for clinicians on how to detox these tiny victims, a new report indicates.
The American Academy of Paediatrics (AAP) has released its first updated guidelines on neonatal drug withdrawal since 1998, partly in response to the escalating abuse of both illicit and prescription drugs by pregnant women and partly in recognition of better pain management techniques for babies who are critically ill.
"There have been pockets of the country where up to 25% of all NICU [neonatal intensive care unit] babies at any given time are being treated for withdrawal," said report co-author Dr Mark Hudak, a professor of pediatrics at the University of Florida College of Medicine in Jacksonville. "The problem has percolated up and reached the attention of government and medical officials."
The report is published online in advance of appearing in the February issue of the journal Pediatrics.
Drugs of choice
Major drugs of abuse include prescription painkillers such as oxycodone, codeine, morphine and methadone, the report noted, along with stimulants such as amphetamines and cocaine and central nervous system depressants such as marijuana, alcohol and barbiturates.
Exposure during pregnancy is linked to a host of problems among newborns, including drug withdrawal upon birth - demonstrated by irritability, poor sucking, tremors, seizures, diarrhoea, vomiting and shrill crying - and long-term issues such as birth defects, impaired growth and behavioural problems.
The report recommended that each hospital nursery develop a system to screen mothers for drug abuse, while confirming exposure in newborns - though not fail-proof - usually entails taking samples of the infants' urine and meconium (their first stool).
Some drug-exposed infants don't exhibit any problems after birth, but first-line treatment for those who do includes comfort measures such as minimising light and sound, swaddling and rocking, and offering high-calorie formula to minimise hunger. If those measures aren't effective, babies may need to be treated with therapeutic drugs to counteract the effects of the other drugs, the report said.
Focusing on the problem
"There are a lot of unknowns, but it's very important that they're focusing on this problem and bringing it to everybody's attention," said Dr Dagmar Liepa, medical director of the inpatient medical detoxification unit at Mission Community Hospital in Panorama City, Calif. "The fact is that these babies are hurting, and have to be in the hospital longer and monitored longer. We don't know what the long-term effects will be."
Hudak said the paper adds information about the effects of maternal antidepressant use, whose effects weren't as clear 14 years ago. It also discusses how to manage pain in newborns that require surgery or other painful treatments, which is better understood since the previous guidelines were issued.
"We need to provide these babies with enough [medication] that they don't feel any pain," he said, "but the flip side is if we treat babies with narcotic painkillers for a long time, they are at a high risk of being addicted."
The report is a "significant expansion" of the AAP's previous guidelines and also points to where further research in the field is needed, Hudak said.
"I think a lot of additional work needs to be done," he said. "It's state-of-the-art information - right now."
(HealthDay, January 2012)
(Copyright © 2012 HealthDay. All rights reserved.)