Breaking the Cycle: Preventing Neonatal Abstinence Syndrome and Nurturing Healthy Beginnings

Three weeks premature, Baby Jessica entered the world weighing only 4 lbs. 12 ounces. Crying inconsolably in the NICU, she experienced tremors, blisters, and severe reflux.

Even worse, she was unable to breathe without assistance. She also had a congenital heart defect. The diagnosis: Neonatal Abstinence Syndrome (NAS). The cause: opioids.

The story of baby Jessica plays out 20,000 times per year. That’s how many infants are estimated to be born with NAS each year.

What is NAS and NOWS?

Unlike AIDS or COVID-19, NAS is not a disease you “catch.” Neonatal abstinence syndrome is a group of conditions caused when an infant withdraws from drug exposure in the womb – most often when a woman takes opioids during pregnancy. Neonatal Opioid Withdrawal Syndrome (NOWS) is the terminology used when withdrawal is due solely to opioid use.

One of the most distressing aspects of NAS is that it is preventable, but due to social stigma and fear of potential legal consequences, including loss of custody, many women (73.3% in one study[4]) hide their substance abuse. As early as 2012, the American College of Obstetricians and Gynecologists developed guidelines for intervening in these pregnancies via opioid agonist pharmacotherapy.[5] In spite of these guidelines, cases like Jessica’s are all too common.

Managing NAS/NOWS at ProgenyHealth

When Jessica was finally able to leave the hospital, her foster mom took her home, unsure how to care for her complex and demanding needs. Fortunately, ProgenyHealth case managers could help the foster mom manage Jessica’s difficulties with feeding, sleeping, and tremors.

NAS Awareness Month

Jessica is a composite of the NAS cases we manage every day. October is Neonatal Abstinence Syndrome Awareness Month, so please take this moment to learn more about the magnitude of the crisis:[5]

• In 2019, 7% of women reported using opioid pain relievers during their pregnancy
• Of those women, 1 in 5 reported misusing those opioids
• Between 2016 and 2020, 28 states experienced a decline in NAS births and 20 states had an increase in NAS rates.[6]
• The cost of a hospital stay in 2017 for an infant born with NAS was over eight times the cost of a typical infant
• The average length of stay for an infant born with NAS is 20 days, as compared to 2 days for a typical infant

These numbers are just the tip of a public health iceberg. An increase in unemployment[7] coupled with a surge of loneliness and depression[8] has driven a stunning rise in opioid misuse.[9]

Common Prescriptions

Opioids mimic the effect of the original source – opium – but now are prescribed as a long list of pain relievers like the semi-synthetic OxyContin® and Vicodin® and dangerous street drugs like heroin.

When adults withdraw from opioids, we understand that withdrawal symptoms follow. The lesser-known fact is that infants who are born dependent on drugs have horrible withdrawal symptoms, too. The difference is that they are defenseless.

Opioid abuse is not just a problem of street drugs and struggling addicts. In many cases, a mother might take prescription medicine for chronic migraine headaches or back pain, not realizing that it may result in her infant undergoing withdrawal.

Drug Withdrawal in Newborns

When an infant is born and the cord is cut, the newborn’s opioid supply is gone, and the infant begins to have signs of physical withdrawal after a few days. The consoling responses a NICU nurse or a mom might give initially – feeding, diapering, holding – don’t always work. Despite these efforts to console, the infant will cry through the withdrawal. Sometimes, the newborn is given teeny drops of an opioid to calm the opiate receptors in the brain.

Groundbreaking NAS Work

Dr. Linda Genen, Chief Medical Officer (CMO) at ProgenyHealth, has been spearheading our work in managing care for infants born with NAS:

“NAS touches so many clinical areas,” Dr. Genen explained. “As one example, we are challenged even to classify NAS using appropriate ICD-10 codes. Additionally, there are the variations in care in treating NAS. This includes variations in toxicology screening, initial comfort care measures, medication-assisted treatment, fortified nutrition, and counseling.[10]

“The Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW) is studying NAS infants across 30 research hospitals to identify the variations in the care for these infants.

“The ultimate solution will be to develop new methods for pain relief that don’t require addictive drugs. The HEAL initiative is looking into non-opioid treatments for neuropathic pain, including chronic pain and migraine, inflammatory pain, and visceral pain.”

To learn more, click here for additional NAS-related content.

1. nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#:~:text=Opioid%2Dinvolved%20overdose%20deaths%20rose,with%2080%2C411%20reported%20overdose%20deaths.
2. www.cdc.gov/drugoverdose/deaths/index.html
3. www.ihs.gov/opioids/covid19/
4. www.ncbi.nlm.nih.gov/pmc/articles/PMC5151516/
5. www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10204012/
7. www.cbpp.org/research/poverty-and-inequality/tracking-the-covid-19-economys-effects-on-food-housing-and
8. news.harvard.edu/gazette/story/2021/02/young-adults-teens-loneliness-mental-health-coronavirus-covid-pandemic/
9. www.bloomberg.com/news/articles/2021-02-20/covid-pandemic-has-only-made-the-opioid-crisis-worse
10. www.cdc.gov/opioids/basics/epidemic.html
11. pediatrics.aappublications.org/content/147/1/e2020008839