From the beginning: A fight for their life

Christy Howell-Hoots - [email protected]
- Terry Prather, The Ledger Independent

(EDITOR’S NOTE: This is the fourth in a series of stories concerning the opioid crisis that our communities are facing, presented as a cooperative effort of The Ledger Independent, WFTM Radio and Comprehend, Inc. Today’s story deals with those who find themselves on the front lines of the fight against addiction — health care providers.)

Doctors have seen a rise in the number of babies born addicted to drugs, not just in the local area, but nationwide.

Dr. Michael Coleman, a pediatrician with KidCare in Maysville, said he has seen a steady rise for several years.

Coleman said doctors will check Finnegan scores once a baby is born if the baby is suspected to have been exposed to drugs during the mother’s pregnancy.

“That is a standardized scoring system used for babies born addicted to drugs,” he said. “We use a certain criteria to do that.”

The major symptoms watched for include:

— Disturbed and non-disturbed tremors.

— Excess stooling.

— Shrill and excess crying.

— Excess sneezing

“There are a few other subtle, but the tremors are the biggest thing you see — that people notice all of the time,” Coleman said.

He also said seizures are, by far, the worst symptoms.

“That’s the end game,” he said. “When a baby starts seizing, they are transferred to Cincinnati’s Children’s Hospital. The seizures are what you’re trying to avoid.”

Coleman said once a baby receives a certain Finnegan score, that is when caregivers will discover if the baby is going into neonatal abstinence syndrome.

“That’s the syndrome the babies go through when they’re going through withdraw,” he said. “NAS is the biggest topic right now in medicine.”

Coleman said doctors initially believed subutex, which is used to help with withdraw symptoms, would not cause withdraw as bad as other drugs.

“We’re learning the withdraw symptoms are just as bad as with other drugs,” he said. “But, it takes longer for them to appear, so when we know a mother has been using subutex during the pregnancy, we will monitor her for 96 hours in the hospital. They have to stay four days, because we typically won’t see many withdraw symptoms until about 48 to 72 hours.”

According to Coleman, if a baby’s symptoms are bad enough, the baby will be treated and weened off the drug just like an adult would be.

“There are different methods,” he said. “Some places use morphine, some use methadone and some use subutext to ween them off. It’s different in every institution and everyone has their own reasons for doing what they do, but all three are acceptable at this point.”

When a newborn is started on medication, it is hospitalized for 10 to 14 days.

“Which, of course taxes the healthcare system, because we’re not used to babies staying in the hospital that long,” he said.

Coleman said every mother is now screened for drugs several times during her pregnancy, beginning with the first prenatal visit and also once the baby is born.

“If the mother is positive, we check urine and meconium and the cord,” he said. “We will send the umbilical cord away for testing. That will give an idea of whether or not the mother has taken drugs during the pregnancy. Something Cincinnati Children’s Hospital does, that we don’t do here, is that if a women tests positive during anytime during the pregnancy, the baby is monitored for 96 hours.”

According to Coleman, at the local offices, doctors do not make the final decision on whether or not the mother is allowed to take the baby home.

“Contrary to popular believe, we don’t make that decision,” he said. “Social services consult is called and they take over from that point. Mostly, that usually depends on what they’re on. If they’re on subutex and taking it legally, that’s one thing, but they’ll look out for someone is taking something illegally, such as heroin or other drugs that are not prescribed. They’ll evaluate and ultimately make that decision.”

There may be many long term issues a baby born addicted may face during its lifetime.

“This is where I take issue,” he said. “I think we have a lot of people who believe that when their child is born addicted, we just ween them off and everything will be alright, but the long term effects are the biggest burden on society.”

Some disorders common to babies born to mothers who use drugs during pregnancy can include:

— Mental disorders and mood disorders.

— Learning disabilities.

— Attention deficit disorders.

“Mental and learning disabilities we know are at an increase,” he said. “As opioid abuse has risen, we’ve seen a rise in our other disabilities in our preschools. You can see a trend that when our drug-addicted babies started to rise, four years later, we have a higher number of children with disabilities. It’s gotten a lot worse.”

Coleman said there are other things doctors will watch for when a woman comes in to take a drug test during her pregnancy.

“People will do almost anything they can think of in order to pass a drug test,” he said. “They’ll even bring in other people’s urine. We’ve actually had to do a pregnancy test on the urine samples because we’ve had dads provide urine for the mom. If you do a pregnancy test on the urine of a mother about to go into labor, it’s going to be positive.”

Coleman said the costs of caring for drug-addicted babies far outweighs that of caring for a healthy infant.

“It’s a good 10 to 20 times the cost of caring for a healthy newborn would cost to society,” he said. “Even after that, they’re going to need monitoring and some may need special formulas. The healthcare costs are astronomical.”

According to information provided by Coleman’s office, in the local area, in 2013, from June to December, there are 45 drug tests conducted on umbilical cords and four babies were treated for NAS; in 2014, 67 cords were test and 20 babies were treated for NAS; in 2015, 34 cords were tested and 20 babies were treated for NAS; in 2016, 52 cords were tested and 18 babies were treated for NAS; in 2017, 52 cords were tested and 16 babies were treated for NAS; as of February 2018, 11 cords were tested and two babies were treated for NAS.

“Heroin and oxycodone are the biggest,” Coleman said. “We also get people on methamphetamine. There have also been parents using marijuana during pregnancy who believe nothing will happen. Even though we may not see withdraw symptoms in the hospital, there have been long term effects show up later.”

As the number of pregnant women using drugs continue to rise, legislators have started to take notice.

U.S. Sen. Mitch McConnell, along with U.S. Sen. Bob Casey, recently drafted a bill, call the Protecting Moms and Infants Act that calls on the Centers for Disease Control and Prevention to work with stakeholders to develop education material on pain management for doctors and expectant mothers.

“To address a complex issue like the opioid epidemic, it is critical that the federal government continues to collaborate with states, communities, and localities to find comprehensive solutions through prevention, treatment and enforcement efforts. Passing this legislation in committee brings us one step closer to helping the increasing number of vulnerable infants born dependent on opioids,” McConnell said.

Women who are pregnant and using drugs, but want to find help can call the National Drug Help Hotline at 1-800-662-4357 or the National Alcohol and Drug Dependence Hopeline 1-800-622-2255. Prather, The Ledger Independent

Christy Howell-Hoots

[email protected]