A new drug problem

A new drug problem

More therapies needed for growing number of newborns exposed to painkillers

By Matt Galnor

Mark Hudak/Photo by Sarah Kiewel

Opioid pain relievers prescribed to pregnant women have been linked to increasing rates of drug withdrawal among newborns, and that means new diagnosis and treatment approaches are needed, a UF pediatrics expert says.

Those higher rates have led to the first comprehensive update and review of the issue by the American Academy of Pediatrics in a decade. The new report, co-authored by Mark L. Hudak, M.D., a professor, chief of neonatology and associate chair of pediatrics at the UF College of Medicine-Jacksonville, was published in the February edition of the journal Pediatrics.

“The more we study the signs of opioid withdrawal and the possible treatments, the more we’ll be able to help these babies,” said Hudak, who was a member of the American Academy of Pediatrics committee on drugs when he co-authored the paper.

Exposure to drugs while in the womb can cause abnormalities in body structure, impair development of the brain and central nervous system and result in drug withdrawal symptoms in newborns.

Diagnoses of neonatal drug withdrawal in Florida are 10 times higher than they were in 1995, according to the Florida Department of Health. Nationally, diagnoses have nearly doubled over the same period, according to the federal Agency for Healthcare Research and Quality.

A decade ago, the most common cause for withdrawal in newborns was maternal abuse of “street” opioids such as heroin, or supervised treatment with methadone to prevent drug withdrawal symptoms and craving for illicit drugs. Today, prescription pain medications that contain opioids such as oxycodone and hydrocodone are increasingly responsible for the withdrawal syndrome seen in babies.

“There is definitely an increase in the number of babies with signs of withdrawal where the mother was legitimately treated for pain by a primary care physician or other medical specialist,” Hudak said.

The challenge for physicians who treat mothers with chronic pain is to prescribe the minimum effective dose of opioid needed or find alternative classes of medication that will not cause infants to have withdrawal. In some cases, interventions such as physical therapy might reduce reliance on drug therapy.

The rapid shift in the causes of neonatal drug withdrawal is one of the reasons the treatment policy was updated, said Daniel Frattarelli, M.D., chair of pediatrics at Oakwood Hospital in Dearborn, Mich., and chair of the American Academy of Pediatrics Committee on Drugs.

“The pattern among babies born with signs of withdrawal has changed quite a bit,” he said. “Even five years ago, it was all street drugs.”

The study tells physicians what to look for and steps to take if they see signs of withdrawal. Treatment includes preventing overstimulation by keeping the baby in a dark, quiet environment, rocking or swaying the child for comfort, and providing frequent small feedings to replenish excess calories lost. Occasionally, intravenous fluids need to be given. Drug therapy is used to relieve signs of moderate or severe withdrawal. Hudak said additional studies are needed to identify the optimal treatment for babies.