The American Academy of Pediatrics (AAP) guidelines are a response to what the group calls an alarming increase in addicted newborns.
In some areas, up to 25% of newborns in neonatal intensive care units are being treated for drug withdrawals.
Prescription Drug Abuse EpidemicBecause prescription drug abuse has increased across the board nationwide, many of those who are addicted to opioid painkillers include pregnant women. Consequently, there has been a corresponding increase in the number of addicted newborns who experience drug withdrawal symptoms.
Some babies are born addicted because their mothers are receiving pharmacological treatment for drug addiction with methadone or buprenorphine. Other mothers are actively addicted to heroin, cocaine, or other illegal drugs.
But after the pain-pill abuse epidemic, most babies who exhibit drug withdrawal symptoms immediately after birth do so because their mothers are abusing or are addicted to prescription painkillers. The Centers for Disease Control reports that non-medical use of prescription opioids has reached epidemic proportions in the United States in the past five years.
New Guidelines PublishedSome infants who were exposed to drugs in the womb experience no withdrawal symptoms at all, the AAP report said; some have only mild clinical signs of withdrawal, but some have much more severe withdrawals, which in extreme cases can be fatal.
To make sure these addicted newborns are identified and given appropriate treatment, the AAP published updated guidelines in the journal Pediatrics. The guidelines include "evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives."
The AAP recommends that all hospitals set up a system to screen mothers for drug abuse and newborns for the presence of drugs by testing the baby's urine and meconium.
Symptoms of Infant Drug WithdrawalInfant drug withdrawal symptoms can include:
- Shrill crying
Long-term symptoms can include birth defects, impaired growth, and behavior problems.
Range of Treatment OptionsTreatment options suggested by the guidelines range from simply making the infant more comfortable -- minimizing exposure to light and sound, or swaddling and rocking -- to using medication to reduce moderate to severe withdrawal symptoms.
If the newborn does not respond to comfort support and shows signs of moderate or severe withdrawal symptoms, the AAP recommends pharmacological treatment to prevent fever, weight loss, and seizures.
According to the AAP, doctors have treated drug withdrawal symptoms in newborns with a variety of drug preparations, including opioids (tincture of opium, neonatal morphine solution, methadone, and paregoric), barbiturates (phenobarbital), benzodiazepines (diazepam, lorazepam), clonidine, and phenothiazines (chlorpromazine).
Pharmacological Treatment Not Always BestHowever, the guidelines caution that pharmacological treatment is not always the best option because it will prolong the baby's drug exposure and lengthen the hospital stay, which could possibly harm maternal-infant bonding.
Use of medication to treat the infant's withdrawal symptoms might also reinforce the mother's tendency to rely on drugs to treat the baby's discomfort or annoying behavior, the AAP warns.
The AAP guidelines suggest that the only real benefit to using pharmacologic treatment with addicted infants is the short-term relief of withdrawal symptoms.
Mark Hudak, M.D., the lead author of the expanded guidelines, said the problem facing pediatricians is finding the right amount of medication to relieve the infants' symptoms and pain without giving them so much medication that they become addicted.
The complete guidelines are available online in PDF format.
Source: Hudak, ML, et al. "Neonatal Drug Withdrawal." Pediatrics. 30 January 2012.