Neonatal expert Pauline Hayes of the University of Louisville’s Center for Women & Infants will outline the issue May 20 at a state health department meeting in Frankfort.
Kentucky cases of neonatal abstinence syndrome (NAS) have increased 11-fold in the past decade — from 67 in 2001 to 730 in 2011. CWI staff began to see a sharp increase eight years ago and began developing new treatment models to address it.
“In 2004, we had about six babies born with NAS all year,” said Hayes, clinical nurse manager for the neonatal intensive care unit (NICU). “That number jumped to nine cases in the first six months alone in 2005.
“We knew then the problem was escalating, and we needed to act.”
Preventing and treating neonatal abstinence syndrome
Gathering a multi-disciplinary team of nurses, physicians, pharmacists, occupational therapists and other professionals, CWI began developing protocols to treat the condition.
While some babies exposed to drugs or alcohol in the womb show no signs of NAS or other problems at birth, “we know that 75 percent of babies exposed in utero will require hospitalization and treatment after birth — and the research available now gives us no way to know in advance which babies will be OK at birth despite exposure and which babies will need treatment,” Hayes said.
“The best option, of course, is to not use alcohol or any unprescribed drug if you are pregnant, but if you are, the next best option is to be honest and tell your obstetrician what you are using so the right protocol can be used.”
Babies born with NAS exhibit signs of irritability and inconsolability. They have gastrointestinal difficulties, fevers and sweating. Excessive sucking and a chronic high-pitched cry also are signs of NAS.
For most babies born now, NAS is a consequence of their mothers’ use of opiates — methadone, oxycodone and others — and heroin, Hayes said. Treating babies with NAS requires gradually weaning them off the substances.
“Our best evidence-based medicine shows that giving drug-for-drug and gradually decreasing the dose works best for these babies,” Hayes said. “We do not want any baby to go home from the hospital still on medications.”
The lasting effects of NAS are still not fully known, she said. “There just isn’t enough research data yet to know what the long-term prognosis for these children will be. Those babies we first saw born in 2005 are now reaching school age, and we don’t yet know fully what the neurological impact will be.
“However, when we treat them, we do see they feel better. They interact with their parents and with the nursing staff, and they seem to be like any other babies by the time treatment is complete and they go home.”
Expectant mothers should not be fearful of seeking help
The key for moms-to-be who take drugs is, she said, “is to not be afraid to tell us what you are using. We are not law enforcement; we are professional health caregivers, and our purpose is to help you and your baby.
“Come to the CWI and don’t be afraid to get care. That is what we are here for.”