How best to treat youngest sufferers of opioid epidemic

Different treatments

CHICAGO, Feb 15, (AP): Two babies, born 15 months apart to the same young woman overcoming opioid addiction. Two very different treatments.

Sarah Sherbert’s first child was whisked away to a hospital special-care nursery for two weeks of treatment for withdrawal from doctor-prescribed methadone that her mother continued to use during her pregnancy. Nurses hesitated to let Sherbert hold the girl and hovered nervously when she visited to breast-feed.

Born just 15 months later and 30 miles away at a different South Carolina hospital, Sherbert’s second child was started on medicine even before he showed any withdrawal symptoms and she was allowed to keep him in her room to encourage breast-feeding and bonding. His hospital stay was just a week.

“It was like night and day”, Sherbert said.

The different approaches highlight a sobering fact: The surge has outpaced the science, and no one knows the best way to treat the opioid epidemic’s youngest patients.

Trying to cope with the rising numbers of affected infants, hospitals around the United States are taking a scattershot approach to treating the tremors, hard-tosoothe crying, diarrhea and other hallmark symptoms of newborn abstinence syndrome.

“It’s a national problem”, said Dr Lori Devlin, a University of Louisville newborn specialist. “There’s no gold-standard treatment”.

With help from $1 million in National Institutes of Health funding, researchers are seeking to change that by identifying the practices that could lead to a national standard for evidence-based treatment. A rigorous multi-center study comparing treatments and outcomes in hard-hit areas could start by the end of this year, said Dr Matthew Gillman, who is helping lead the effort.

“When there’s so much variability in practice, not everyone can be doing the very best thing”,

Gillman said.

Symptoms

Once the umbilical cord is cut, babies born to opioid users are at risk for developing withdrawal symptoms. By some estimates, one infant is born with the condition in the US every 25 minutes. The numbers have tripled since 2008 at a rate that has solid medical research comparing treatments and outcomes struggling to keep pace.

Not all opioid-exposed babies develop the syndrome, but drug use late in a pregnancy increases the chances and can cause dependence in fetuses and newborns. These infants are not born with addiction, which experts consider a disease involving compulsive, harmful drug-seeking behavior. But the sudden withdrawal of opioids from their mothers may cause increased production of neurotransmitters, which can disrupt the nervous system and overstimulate bodily functions. Symptoms can last for months.

The condition can result from a mother’s use of illicit drugs, but it also can stem from mothers being prescribed methadone or other anti-addiction medicine. Doctors believe the benefits of that treatment for the mothers outweigh any risks to their infants.

The Centers for Disease Control and Prevention doesn’t routinely track the condition, but the agency’s most recent data — from 2014 — indicates that the syndrome affects nearly 11 in every 1,000 US births. The CDC said it is working with the March of Dimes and several states to get a better picture of the number of affected infants and how they fare developmentally and academically into childhood.

Some studies have suggested possible increased risks for developmental delays and behavior problems, but no research has been able to determine if that’s due to mothers’ drug use during pregnancy, infants’ treatment after birth or something completely unrelated. And there’s no definitive evidence that these children fare worse than unexposed youngsters.