Opiate Addiction Sometimes Begins in the Womb

Nov 24, 2015

Neonatal abstinence syndrome, or NAS as it’s known in the medical community, is yet another problem that stems from the heroin epidemic ravaging West Virginia. NAS occurs in newborns exposed to opiates while still in the womb. When they’re born, they feel the full effects of withdrawal.

Health care professionals are now trying to come up with ways to track and deal with the problem more effectively.

Symptoms of NAS include tremors, seizures, vomiting and excessive crying. These may begin as early as 24 to 48 hours after birth, and some may last as long as four to six months.       

“Right now, we have six babies in NICU, and five of them are drug-exposed or addicted,” said Meggan Beckner, a nurse in the neonatal intensive care unit at Thomas Memorial Hospital, in South Charleston. She has seen the number of cases dramatically increase in her eight years there.

“And that’s not including babies that haven’t been admitted to the NICU, but are here as what we call ‘border babies,’ that stay here for observation that could possibly be admitted that haven’t been started on medication or transferred to the NICU yet,” she said. “When I came here back in 2007, maybe one in eight; one in 10, if that. Right now, it ranges; it’s between usually about 50 to 70 percent.”

We believe it's underreported. Certainly these babies are being identified, and they're being treated, but it's not like there is a data collection system that says if these babies had NAS, check this box and send it in.

Unreliable Numbers

According to an analyst with the West Virginia Department of Health and Human Resources, there were about 20,500 babies born in West Virginia in 2014. Nearly 660 of those newborns suffered from NAS. But those numbers are likely to change as more data are crunched. And even then, the numbers really aren’t too reliable.

“We believe it’s underreported. Certainly these babies are being identified, and they’re being treated, but it’s not like there is a data collection system that says, ‘if these babies had NAS, check this box and send it in,’ ” said Amy Tolliver, director of the West Virginia Perinatal Partnership, an organization working to improve pre- and postnatal health in the state. “And one of the reasons is because there’s a difference among providers in regard to what are we calling it? When do we call it NAS?”

While one hospital will diagnose and report neonatal abstinence syndrome as soon as withdrawal symptoms become obvious, another hospital might not report that an infant has NAS unless medication is administered.  

There’s a scoring system that determines whether the newborn will receive medication. The higher the score, the worse the symptoms.

“And you can just see it. These babies have a look on their face that’s just kind of, “I don’t feel good,” Beckner said.

She said that infants are evaluated every four hours, if symptoms persist, a physician steps in.

“They’ll look the baby over, do an exam, check the scores out and, based on all of that, they’ll determine whether or not they’re a candidate to be, or need, medicated. Typically, if the scores get that high at that point, they’re not going to go back down. It just progressively gets worse.”

Finnegan System

It’s called the Finnegan Neonatal Abstinence Scoring System. Newborns are scored according to categories, and subcategories -- 31 items in all. While this is the most comprehensive test for NAS, at least one national study found that many nurses say the system is too complicated and don’t use it regularly.  

Prenatal Partnership director Amy Tolliver said virtually all hospitals in West Virginia use the Finnegan Scoring System. Her organization is training nurses in the state to use the test more effectively. The goal is to create consistent diagnosis and provide reliable data.

There are also efforts to deal with the issue at the national level. Congress recently passed the Protecting Our Infants Act. The bill will require the Centers for Disease Control and Prevention to expand data collection and surveillance of children with neonatal abstinence syndrome.