Doc­tors stumped on how best to treat opi­oid-ad­dicted ba­bies

The Oklahoman - - NATION | WORLD - BY LIND­SEY TAN­NER

CHICAGO — 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-to-soothe 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 mul­ti­cen­ter 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.

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 U.S. 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 U.S. 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.

“It’s very, very frus­trat­ing” not know­ing those an­swers, Devlin said. “It’s such a dif­fi­cult pop­u­la­tion to go back and do re­search on. They’re peo­ple who of­ten don’t trust the sys­tem, of­ten peo­ple who have had lots of trauma in their lives.”

Treat­ment aims to re­duce or even pre­vent symp­toms. Some hos­pi­tals use mor­phine drops, while others use methadone and some­times seda­tives. Some send the ba­bies straight to new­born in­ten­sive care units and some fo­cus on com­fort care from moms, al­low­ing them to room-in with their in­fants. A re­cently pub­lished Dart­mouthHitch­cock Med­i­cal Cen­ter anal­y­sis linked roomin­gin with less med­i­ca­tion use and shorter hospi­tal stays for in­fants, but it can be dif­fi­cult if mothers are still in the throes of ad­dic­tion.

A Florida hospi­tal is even test­ing tiny acupunc­ture nee­dles on af­fected in­fants.

Many hos­pi­tals use a 40-year-old scor­ing sys­tem to mea­sure 21 symp­toms and frame di­ag­no­sis and treat­ment length, but some have cre­ated their own scales.

It’s such a dif­fi­cult pop­u­la­tion to go back and do re­search on. They’re peo­ple who of­ten don’t trust the sys­tem, of­ten peo­ple who have had lots of trauma in their lives.”

Dr. Lori Devlin, a Univer­sity of Louisville new­born spe­cial­isy

[AP

Sarah Sher­bert poses for a photo Feb. 5 in An­der­son, S.C., hold­ing pho­tos of her chil­dren when they were in­fants. The two ba­bies, born 15 months apart when she was over­com­ing opi­oid ad­dic­tion, got two very dif­fer­ent treat­ments at two dif­fer­ent South Carolina hos­pi­tals. The dif­fer­ent ap­proaches high­light the fact that no one knows the best way to treat the opi­oid epi­demic’s youngest pa­tients.

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