The opioid crisis doesn’t seem to be slowing down, even right here in South Dakota. The crisis is even affecting the tiniest of victims, newborns who are born addicted to opioids.
“It's not something I went into the field for. This is not something I want to be one of our bigger problems. It's really kind of tragic how out of control this has gotten and how quickly it has gotten there,” said Dr. Katherine Wang, medical director of the Avera McKennan NICU.
Dr. Wang, like doctors across the country, is treating more newborns with Neonatal Abstinence Syndrome (NAS) because of the opioid epidemic.
“It is a little bit of a catch-all term for babies that have been exposed to drugs in utero, meaning while in mom's tummy during the pregnancy,” said Dr. Wang.
Each chemical or drug used in utero causes different reactions in newborns.
“These babies, it really is almost like you think there's something wrong -- like maybe a broken bone or something because they seem to be so irritable all the time. They have problems eating. Sometimes they'll actually have constant diarrhea making it harder and then they get bad rashes because of that. They also can have a lot of jitteriness – so shaking. So with opiates, what you're having is, if mom has been constantly using, they've had a steady supply and their body actually adapts to that and the brain cells basically think accordingly that it’s supposed to be there. So when you take that away, suddenly the body kind of doesn't know what to do and that’s where you get the withdrawal symptoms,” said Dr. Wang.
The standard of care for NAS usually consists of very tiny doses of opioids like morphine or methadone to ween newborns off the drug. As the symptoms come under control, the dosage gets smaller and smaller until they’re off opioids completely.
In the last two years, Dr. Wang says she’s treated five to 10 babies a year with neonatal abstinence syndrome. In response to the opioid crisis, the Avera McKennan NICU implemented a protocol to better care for babies with NAS.
“When there's a protocol in place that's very clear – if a, then b, then b, then c, the babies get to go home faster probably because everyone is following the same set of rules versus if I have one doctor and then two weeks later another doctor who's decreasing at a different rate – maybe it's not happening as quickly as you would like,” said Dr. Wang.
So what happens when the baby grows up? As Avera child psychiatrist Dr. Nicole Christenson explains, the effects can be long term.
“I usually get the kids when they start to get to age three or four and then we start to see the emotional behavioral effects that come from being exposed in utero to opioids or other chemicals,” said Dr. Christenson.
Dr. Christenson says hyperactivity and ADHD symptoms are common in kids that are exposed in utero to a variety of chemicals like opioids, marijuana and alcohol.
“A lot of kids also that are exposed to opioids will have a lot of what we call internalizing behaviors, which is your anxiety, your nervousness, symptomatic complaints like tummy aches, headaches, things like that. And those are harder to pick up than the externalizing behaviors that everybody talks about like hyperactivity, aggression, impulsivity,” said Dr. Christenson.
What both doctors want moms to know, help is available.
“I do think one of the things that's encouraging is we do get a lot of moms who are on methadone programs, which to me is great because it means it's a mom who is ready to make a change,” said Dr. Wang.
“I want parents to know, don't beat yourself up over this. Addiction is a health issue just like any other health issue and we want to be able to get you healthy and get your child healthy and be successful,” said Dr. Christenson.
To put it in perspective, a mom who has a normal delivery and healthy baby can go home in two days. If a baby was born cesarean, they go home in three days. But, a baby who has symptoms of NAS could be in the NICU anywhere from one week to several months.