Newborns addicted to opiates climbing in Ozarks

SPRINGFIELD, Mo. -- On any given day, their high-pitched cries echo throughout neonatal intensive care units.

They are pained, agitated, unable to sleep or eat, nauseated, jittery and screaming.

"Inconsolable," said Dr. Melinda Slack, medical director of neonatal at Mercy Children's Hospital in Springfield.

"They are so -- we refer to it as 'jacked up' -- they can't eat."

They are babies born addicted to opiates including certain painkillers, such as codeine, morphine, oxycodone or methadone, or illegal drugs like heroin.

And according to Slack, who has been the head of Mercy's NICU for 32 years, it has become an epidemic in the Ozarks, mirroring the national trend, the Springfield News-Leader reported.

"We typically think of Missouri as a meth state. But when we look locally, it appears the opiates have taken the lead," Slack said. "One time we had nine (opiate-addicted babies) in the intensive care unit.

"It's difficult to see babies who have a preventable illness show up," she said. "And this is preventable."

In 2014, 13 babies were admitted to Mercy's NICU because they required medication to ease withdrawals. Slack said they already have met that number for 2015.

CoxHealth's NICU also has seen an increase. According to Dr. Joseph Eccher, CoxHealth neonatologist and NICU medical director, five opiate-addicted babies were admitted to the NICU in 2010. By 2014, that number had climbed to 30.

Those numbers reflect only the babies who were admitted to the NICU because they required medication to ease withdrawals. Many babies can be treated in the regular nursery, Eccher noted.

Not all babies exposed to opiates in the womb present withdrawal symptoms, Slack said. And some babies exposed to opiates in the womb can be treated with environmental modifications such as providing a quiet environment, low light and swaddling.

It all depends on how much the mother was using and how long since she last used.

But roughly 60 percent of the babies do require medication (typically methadone or morphine) to wean them, as well as a stay in the NICU for an average of 20 to 30 days, Slack said.

Symptoms and signs of withdrawal involve the brain and nervous system as well as the digestive system. Babies are often agitated and overstimulated with no way to self-soothe and calm down.

They might have diarrhea, vomiting and be unable to eat, which can quickly cause an infant to become dehydrated. Some babies have seizures during the withdrawal process, Eccher said.

If the baby is not in the hospital or with parents who understand what the child is going through and how to care for it, the child is at risk for abuse and neglect, Eccher said.

"Imagine you have the most irritable baby in the world and it screams and cries nonstop. And it never sleeps and it won't eat," Eccher said. "Even with the most loving parent, if they can't deal with it? Those babies are very irritable. If parents don't have an understanding of what is going on, they really do belong in a place where they can receive appropriate treatment (and) where mom and dad can receive appropriate education and a break every once in a while.

"Our nurses take care of these babies," he added. "And help Mom learn how to deal with that baby before the baby goes home."

An important point to make, Eccher said, is pregnant moms who use opiates are not necessarily bad people. Many of the women were prescribed an opiate for a good reason -- to ease pain from a traumatic injury, for example. Some moms might be taking an opiate that was once prescribed to them by a doctor, but they never were able to quit taking the drugs.

"It's becoming increasingly problematic among adults who end up being put on prescription pain relievers, which then they rapidly become addicted," he said. "If they become pregnant, it sets up the situation of a baby who is then exposed."

Eccher estimates about half of the opiate-addicted moms he sees are using illegal narcotics such as heroin.

Once an addicted mom discovers she is pregnant, it's usually recommended she not quit cold turkey. Instead, she should work with medical professionals to reduce the dosage as much as possible.

"We have to remember that the mother has developed the chemical dependence on that (opiate). And the symptoms they have, the symptoms of pain and the symptoms of withdrawal from that opiate, are very real and do create problems for the pregnancy," he said.

And while it's not a good idea to send a baby home with the mother if she is abusing drugs, putting her in jail is not the answer, Slack said.

"If we alienate them by law, if we are going to take legal action (and) incarcerate these women, you won't be able to find them. They won't get prenatal care," Slack said. "She should be seeing her doctor regularly."

Once the baby is born, the doctors said, it's important mom and baby be together -- when possible and with nurse supervision.

"We try to get them to come and be by the bedside as much as possible so they can appreciate the consequence of their drug use. It is not punishment, but it's a reality test," Slack said. "And we teach them how to use environmental factors like low lighting, quiet environment, and swaddling to soothe."

"It is one time when mothers are highly motivated to get clean," Slack said. "Mothers love their babies. We need to be sympathetic to these people. But for the grace of God, go I."

Eccher agreed.

"You have moms who are struggling with life in general, and sometimes that is part of the reason they find themselves pregnant and of drugs of abuse," Eccher said. "Our job is to help those babies, and a part of helping those babies is to help the moms."

Information from: Springfield News-Leader, http://www.news-leader.com