According to data from tn.gov, 485 Tennessee newborns have been diagnosed with neonatal abstinence syndrome so far this year. NAS is what medical professionals call a cluster of symptoms a newborn shows when it is born withdrawing from drugs that the mother used during pregnancy.
Dr. Des Bharti, a neonatal specialist at Niswonger Children’s Hospital, said infants who are born withdrawing could be addicted to any number of drugs, from narcotics to antidepressants and anxiety medication, and the syndrome can sometimes be difficult to treat after birth.
Bharti said a baby with NAS is scored on what’s called the Finnegan system.
The score is based on the newborn’s symptoms that have to be monitored around the clock — a shrill, high-pitched cry, irritability, loose watery stool, bad diaper rash and insomnia. Some NAS babies suffer from seizures.
A typical hospital stay for a NAS baby can last as long as three weeks and cost upward of $45,000 per child to treat. Treatment starts by giving the newborn a small dose of medicine — typically 0.1 milligram for every kilogram of weight, Bharti says — and slowly weaning the baby off the drugs while keeping an eye on its Finnegan score.
“Our basic idea of admitting them to the hospital here is to treat them with the medication or without medication and make sure they are comfortable and stable at the time of discharge,” Bharti said. “When we do treat them with drugs, our idea is to bring them to a state where they can be managed at home.”
But some cases are harder to treat than others.
Ideally, Bharti said, a NAS newborn would receive treatment with the same medication it was used to, but that’s not always possible. Suboxone, also known by its generic name buprenorphine, is not approved for use in newborns, so those babies are typically treated with morphine – which doesn’t always work. Babies addicted to drugs like an anti-anxiety medication usually receive a concoction of drugs as treatment.
Treating hundreds of NAS babies per year isn’t something Bharti did on a regular basis when he started working at the hospital 25 years ago. In 1990, the hospital treated just a couple of babies with NAS, but Bharti said he noticed the numbers begin climbing in the early 2000s, soaring at alarming rates — about 200 NAS babies out of 568 neonatal ICU admissions this year.
In Tennessee, babies born with NAS has increased elevenfold since 1999, ranking it as the state with the highest percentage of NAS births in the nation. The northeast region has the highest numbers in the state, with almost 18 percent of the state’s cases reported here.
So what can be done to fix it?
That’s a tall order with no easy solution, said women’s health nurse practitioner Joy McLain. McLain works with the Sullivan County Health Department in one of the most heavily affected counties in Tennessee.
McLain said that the medical community has been shifting to high gear to try to combat the growing epidemic within the last couple of years.
Public health works to intervene in three ways, McLain said, the first of which is educating the public on handling their prescription medications by locking them up and disposing of excess medication at one of the health department’s drop boxes around the area.
“Knowing those tidbits of how to handle your narcotics at home are really going to make a difference, because over 55 percent of people who are struggling with addiction get their opioids free from a family member or a friend,” McLain said.
Secondly, the health department works to make sure contraception is available for women of childbearing age who are in substance abuse treatment programs or are struggling with addiction. In non-substance-abusing women, the rate of unintended pregnancy hovers around 50 percent, McLain said, but for woman who are addicted to substances, that number jumps to 86 percent.
McLain said the health department is working to insert itself into the community through churches, schools and anti-drug coalition programs. The health department has also started going to methadone clinics so women can get the education they need about NAS and pregnancy while also working to make sure clinic providers are connected with obstetricians to help educate local women.
“The fact that we have only 18 percent of those women are on birth control lets us know that we're either not making it available to them or we're not getting the education out there so that they know where to go,” McLain said.
Lastly, McLain said the health department works on the cases of NAS babies after they’re born to monitor the child for any possible developmental delays and prevent another pregnancy that could result in another baby with NAS. The department sends nurses into the home to help monitor NAS babies and their environment.
Pointing to recent data, McLain said that while the problem has been rising over the years, it appears the rate of growth has slowed from last year. That might be due to the medical community working to find solutions to the problem, resulting in more than 400,000 fewer opioid prescriptions being written in the past year.
Even with important strides being made by the medical community to combat the area’s drug problem, McLain said, a big contributor to the addiction epidemic is a cultural idea that everything can be fixed with a pill. While changing culture is no small feat, McLain said, the continuing efforts in the battle against addiction coupled with a communal understanding of the disease will begin to bear the fruit of progress within the next few years.
“Addiction is one thing that isn't picky about who it chooses,” she said. “It crosses all socioeconomic barriers, so it's something that we all have to participate in the discussion.”
Communication with health professionals is key for pregnant women struggling with substance abuse, and Bharti said that the last thing a pregnant woman wants to do is treat the addiction herself without consulting a doctor. By cutting down on dosages or eliminating them completely, the fetus, who is already addicted, could become irritated and trigger premature labor.
And premature labor results in premature babies, which may not show NAS symptoms at their time of birth even though they have been exposed to substances in the womb.
“There's a huge number of premature babies that might be exposed to the same substance, but they're not going to have symptoms because their brain is not developed yet,” Bharti said. “You've got to have an intact, developed brain to show symptoms.”
The danger with premature babies being exposed to substances, Bharti said, is that they could possibly be discharged without treatment before any symptoms arise. A NAS baby who isn’t treated could face a significant development delay, Bharti said, because growth hormones are released when the baby sleeps.
Since NAS babies are difficult to comfort, those without treatment get very little sleep, leading to the release of less growth hormones.
In addition to the myriad complications and concerns carried with a NAS baby, sudden infant death syndrome, or SIDS, tops them all for those in the medical community. While there hasn’t been a direct correlation between NAS and SIDS, Bharti said he has seen three NAS babies return to Niswonger dead just 48 hours after discharge within the past two years.
And that doesn’t count children that might have been brought to a different hospital after discharge, but even three is too many, Bharti said.
“Nobody wants to talk about it; for some reason we all look at it and ignore it. ‘It's not our problem.’ But it is our problem, because they're our children and this is our community,” he said. “We need to intervene, we need to do something.”
Email Jessica Fuller at firstname.lastname@example.org. Follow Jessica on Twitter @fullerjf91. Like her on Facebook at www.facebook.com/jfullerJCP.