Every Hour a Baby is Born Addicted to Opioids

Neonatal Opioid Withdrawal Syndrome (NOWS)

Neonatal Opioid Withdrawal Syndrome (NOWS) is a condition that affects infants who have been exposed to opioids during pregnancy. Every year in the United States, tens of thousands of babies are exposed to opioids in the womb, leading to many showing signs of withdrawal after birth. NOWS can have a significant impact on the health and well-being of these infants.

Impact on Infants

Infants with NOWS can exhibit a variety of symptoms, which result from the effects of opioids on their gastrointestinal and central nervous systems. These symptoms may include tremors, feeding difficulties, vomiting, diarrhea, excessive crying, irritability, poor weight gain, and respiratory problems. The severity and onset of these symptoms can vary based on factors such as the type and amount of drugs the mother used during pregnancy.

Many infants with NOWS require long hospital stays, intensive medication and management, and ongoing social services or foster care placement. The care needed for these infants can result in significant economic costs [1]. It is crucial to implement appropriate treatment approaches to support these vulnerable infants.

Treatment Approaches

Treating infants with NOWS requires a multidisciplinary approach involving healthcare professionals, including neonatologists, pediatricians, nurses, and social workers. The goal of treatment is to manage the withdrawal symptoms, support the infant's growth and development, and address any potential complications.

Pharmacological interventions are commonly used to alleviate withdrawal symptoms in infants with NOWS. Medications such as morphine or methadone may be administered in a controlled manner to help manage the withdrawal symptoms and gradually wean the infant off opioids. The dosage and duration of medication treatment can vary depending on the severity of the symptoms and the specific needs of the infant.

Non-pharmacological interventions also play a crucial role in the treatment of infants with NOWS. These interventions focus on creating a soothing and nurturing environment for the infant. Techniques such as swaddling, gentle rocking, and skin-to-skin contact can help comfort the infant and reduce withdrawal symptoms.

Supportive care is essential for infants with NOWS. This may include ensuring proper nutrition through specialized feeding plans, monitoring vital signs, and addressing any other medical needs that may arise. Social services may also be involved to provide support to families and ensure that appropriate resources and services are available for the infant's well-being.

By implementing comprehensive treatment approaches that combine pharmacological and non-pharmacological interventions, healthcare professionals can provide the necessary support to infants with NOWS and help them navigate the challenges associated with opioid withdrawal.

ACT NOW Programs

In response to the growing crisis of Neonatal Opioid Withdrawal Syndrome (NOWS), several ACT NOW programs have been developed to address the needs of infants affected by opioid exposure. These programs aim to provide effective treatment and support for infants and their families.

Eat, Sleep, Console (ESC) Trial

One prominent ACT NOW program is the Eat, Sleep, Console (ESC) clinical trial. This trial is testing a non-medication treatment approach for NOWS in approximately two dozen hospitals nationwide by involving families in comforting the babies and helping them eat and sleep. The ESC trial has shown promising results in addressing NOWS without relying solely on medication [1].

By actively involving families in the care of infants with NOWS, the ESC trial recognizes the importance of parental support and nurturing in the healing process. This approach allows parents to play an active role in comforting their babies, promoting better eating and sleeping patterns. The ESC trial offers a promising alternative to medication-based treatments, with the potential to minimize the need for pharmacological interventions.

Longitudinal Study

The ACT NOW Longitudinal Study is another significant initiative aimed at understanding the long-term effects of opioid exposure on children's development. This study plans to enroll a minimum of 200 babies born to mothers who used opioids during pregnancy, as well as another 100 babies not exposed to opioids as a comparison group. The study will follow these infants until at least the age of two, allowing researchers to assess the long-term impacts of opioid exposure on their cognitive and developmental outcomes.

By conducting a longitudinal study, researchers can gain valuable insights into the potential developmental delays and cognitive impacts associated with prenatal opioid exposure. Understanding these long-term effects is crucial for developing effective interventions and support systems to mitigate the impact of opioid exposure on children's overall well-being.

The ACT NOW Longitudinal Study has the potential to inform healthcare providers, policymakers, and families about the long-term consequences of opioid exposure during pregnancy, facilitating the development of targeted interventions and support services for these children.

These ACT NOW programs are paving the way for innovative approaches to address the challenges of NOWS and prenatal opioid exposure. By combining research, clinical trials, and longitudinal studies, these programs aim to improve the outcomes for infants and children affected by opioid exposure. Continued efforts in this field are essential to ensure the well-being and healthy development of these vulnerable individuals.

NAS Statistics and Trends

The incidence of Neonatal Abstinence Syndrome (NAS) has seen a significant increase in recent years, highlighting the growing impact of opioid addiction on newborns. Understanding the statistics and trends associated with NAS is crucial in addressing this concerning issue.

Increase in NAS Cases

Between 2000 and 2012, the number of babies born with NAS increased five-fold, affecting an estimated 21,732 infants. The rise in NAS cases is alarming, with almost 9 out of 1,000 infants born suffering from Neonatal Opioid Withdrawal Syndrome (NOWS) by 2016. To put this into perspective, it translates to about 90 infants per day, or 1 every 15 minutes, being born physically dependent on opioids. The prevalence of opioid use during pregnancy has played a significant role in this increase, as between 1999 and 2014, the number of pregnant women with opioid use disorder (OUD) rose from 1.5 to 6.5 cases per 1,000 hospital births [4].

Regional Variances

The impact of NAS is not uniform across regions, with variations observed in different areas. Rates of NAS can range from 1.2 to 8.0 cases per 1,000 hospital births, with some areas reaching as high as 20.0 cases per 1,000 hospital births [4]. This regional variance highlights the need for targeted interventions and resources in specific areas heavily affected by opioid addiction.

It is essential to address the increasing number of NAS cases and regional variances by implementing comprehensive strategies that focus on prevention, treatment, and support for mothers struggling with opioid addiction. By raising awareness, improving access to addiction treatment programs, and providing resources for prenatal care, we can work towards reducing the devastating impact of opioid addiction on newborns and their families.

Innovative Treatment Technologies

In the quest to address the challenges posed by Neonatal Opioid Withdrawal Syndrome (NOWS), innovative treatment technologies have emerged as potential solutions. These technologies aim to alleviate the symptoms experienced by infants affected by opioid exposure. Two such advancements are the vibrating bassinet pad and the neurostimulation device.

Vibrating Bassinet Pad

The Prapela SVS hospital bassinet pad is an example of a vibrating technology that has shown promise in improving the well-being of infants with NOWS. This pad produces gentle, random vibrations that have been found to enhance breathing, heart rate, and muscle relaxation in these infants. Studies have demonstrated that exposure to vibrations for 30-minute intervals over a 6- to 8-hour session significantly improved these physiological parameters, offering potential relief for infants facing withdrawal symptoms.

Neurostimulation Device

Another innovative treatment technology that has shown potential in helping infants with NOWS is a wearable neurostimulation device. This device wraps around an infant's ear and delivers soothing electrical signals to stimulate the baby's dysfunctional nervous system. The aim of this stimulation is to prompt the release of endorphins, which can help control withdrawal symptoms. Clinical trials of this device, known as "Roo," have demonstrated promising results. The trials indicated a reduction in the duration infants required morphine treatment, suggesting the potential effectiveness of this neurostimulation approach [3].

These innovative treatment technologies offer a glimmer of hope in the battle against NOWS. The vibrating bassinet pad and neurostimulation device represent advancements that aim to improve the physiological and neurological well-being of infants affected by opioid exposure. Continued research and development in this field may lead to further breakthroughs in supporting the health and development of these vulnerable infants.

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Long-Term Effects of Opioid Exposure

Exposure to opioids during pregnancy can have long-term effects on the development and cognitive abilities of the affected child. It is crucial to understand these potential impacts to provide appropriate support and intervention. Two significant areas of concern are developmental delays and cognitive impacts.

Developmental Delays

Children with prenatal opioid exposure (POE) are more likely to experience developmental delays compared to their unexposed peers. A meta-analysis of 14 studies revealed a significant difference in motor development, with children exposed to opioids showing lower motor scores than controls. This indicates a small to moderate effect size, emphasizing the impact of opioid exposure on motor skills. These delays in motor development can manifest in difficulties with coordination, movement, and reaching developmental milestones.

Cognitive Impacts

Prenatal opioid exposure has been associated with lower cognitive scores in children. A systematic review and meta-analysis of 26 studies found that children exposed to opioids during pregnancy had lower cognitive scores compared to unexposed children. The most significant differences were observed between the ages of 6 months and 6 years. These negative consequences on neurocognitive development seem to persist beyond school age, indicating long-term effects.

Neurocognitive testing has shown that the differences associated with prenatal opioid exposure occur across a wide age range. The negative association with cognitive and motor development begins as early as 6 months and persists during school age. It is important to note that the exact causes and associations of these findings with clinical factors and environmental adversities require further exploration. However, it is clear that children with prenatal opioid exposure should be provided with long-term support and intervention beyond infancy to address these potential cognitive impacts.

Understanding the long-term effects of opioid exposure is crucial for healthcare providers and educators involved in the care and support of affected children. By recognizing and addressing developmental delays and cognitive impacts, appropriate interventions can be implemented to optimize the developmental outcomes of children exposed to opioids during pregnancy.

Prenatal Opioid Exposure (POE)

Prenatal opioid exposure (POE) is a growing concern, with at least 1 in 5 pregnant women in high-income countries known to have used opioids during pregnancy. This increase in opioid use during pregnancy has been associated with various health risks for babies and cognitive development challenges.

Health Risks for Babies

The incidence of prenatal opioid exposure has been linked to an increased risk of perinatal problems, including neonatal abstinence syndrome (NAS), prematurity, and low birth weight. The number of babies affected by NAS has increased by more than 400% in the past two decades, resulting in significant consumption of healthcare and social resources JAMA Network Open. In the United States alone, public expenditure on hospital care for newborns with NAS exceeds $1 billion per year. These health risks emphasize the importance of addressing the impact of prenatal opioid exposure and supporting affected infants.

Cognitive Development Challenges

Children with prenatal opioid exposure may face cognitive development challenges. A meta-analysis of 26 studies found that prenatal opioid exposure was associated with lower cognitive scores compared to unexposed children. The largest difference in cognitive scores was seen between ages 6 months and 6 years, indicating a negative impact on neurocognitive development JAMA Network Open. Furthermore, differences in neurocognitive testing associated with prenatal opioid exposure were found across a wide age range, suggesting that the negative association with cognitive development persists into adolescence.

The exact causes of these cognitive development challenges are not fully understood. However, the findings highlight the need for long-term support and intervention for children with prenatal opioid exposure beyond infancy. By providing appropriate support and intervention, we can help mitigate the long-term cognitive impacts and improve the outcomes for these children.

Understanding the health risks associated with prenatal opioid exposure and the cognitive development challenges that these infants may face is crucial. By raising awareness and providing necessary support, we can work towards minimizing the impact of prenatal opioid exposure on the well-being and cognitive development of affected children.

References

• [1]: https://heal.nih.gov
• ‍[2]: https://www.aamc.org
• ‍[3]: https://heal.nih.gov
• [4]: https://www.frontiersin.org
• ‍[5]: https://jamanetwork.com