ADDICTED BABIES

Technically, the term addicted babies should refer to infants who are born passively physically dependent on drugs. In practice, it is used to refer to all babies extensively exposed to drugs before birth. According to a recent federal government report estimated that in the United States each year some 320,000 babies are born exposed to alcohol and illicit drugs while in the uterus; a far larger number have been exposed, in utero to sedatives and nicotine. The increased recognition of such drug-exposed babies parallels the dramatic increase in drug use, both licit and illicit, by women since the beginning of the 1970s.

Drug-addicted women often use multiple substances—including Alcohol, Nicotine, Marijuana, Tranquilizers, Cocaine, and Opioids (e.g., Heroin and Methadone). The drugs are carried across the placenta from mother to fetus. The clinical presentation of the newborn (neonate) depends on the substance, the amount and frequency used during pregnancy, and the time since last use. Withdrawal will occur in 55 to 94 percent of infants exposed to heroin and other opioids. Infants of regular heavy users usually have a low birth weight, because of intrauterine growth retardation and frequent premature births.

If the mother has used a large dose of depressant drug (alcohol, any number of sedative-hypnotics, or heroin) immediately before delivery, the neonate may have respiratory depression and may require resuscitation. If the mother has used one of these drugs regularly during pregnancy, there may be a neonatal abstinence or withdrawal syndrome, which has as key features irritability, tremor, and increased muscle tone. Other symptoms include poor nervous system irritability, gastrointestinal disorders that lead to poor feeding, vomiting, and diarrhea; high-pitched cry; difficulty in sleeping; and sneezing, sweating, yawning, nasal stuffiness, rapid breathing, and seizures. Withdrawal from heroin generally occurs within forty-eight hours of birth, but it can be somewhat delayed with the longer-acting methadone. Alcohol-exposed infants may develop a very similar withdrawal syndrome, except with the more frequent occurrence of seizures.

Cocaine, a stimulant, constricts blood vessels, thereby decreasing oxygen delivery to the fetus. Consequently, neonatal stroke has occurred. Although cocaine withdrawal symptoms have been reported in neonates, they probably reflect acute cocaine intoxication when the mother's last use was close to the time of birth. Such infants often appear less alert and less responsive to external stimuli than noncocaine-affected newborns, which may represent true withdrawal—comparable to the so-called crash seen in adults.

MANAGEMENT

A thorough alcohol and drug history should be obtained from the expectant mother—and this should be corroborated by testing the urine of both mother and newborn for alcohol and other drugs. Newborns should be closely monitored for signs of withdrawal for a minimum of forty-eight to seventy-two hours, and longer when the mother has been on Methadone-maintenance treatment. Since symptoms of withdrawal are nonspecific and may be confused with a variety of infections or metabolic disturbances, a search for concurrent illness to explain any symptoms is mandatory.

Most hospital nurseries use a standardized neonatal abstinence-syndrome scoring system. After the infant is born the hospital will monitor their sleep habits, temperature, and weight. The earliest withdrawal symptoms are treated by intravenous fluids, swaddling, holding, rocking, a low-stimulation environment, and small feedings of hyper-caloric formula—for weight gain. If symptoms continue or increase, medication may be initiated. Common medications include Paregoric (camphorated tincture of opium), or Phenobarbital for opioid withdrawal; Phenobarbital or Diazepam for alcohol withdrawal. Diazepam is also used to help with cocaine hyper excitability.

Interviewing the mother is essential in reviewing the anticipated home environment. Unfortunately, addicted babies are often at high risk for either abuse or neglect or both. Normal maternal-infant bonding is difficult in the case of an irritable poorly responding neonate and a mother dealing with the guilt, low self-esteem, poverty, inadequate housing, and an abusive or absent partner or parent, which often accompany her own drug addiction. A referral to child protection services may therefore be indicated.

OUTCOME

Some studies have indicated that addicted babies have an increased risk for breathing abnormalities and sudden infant death syndrome (SIDS). Many studies of opioid-exposed children up to school age show few differences from nonexposed children of a similarly disadvantaged environment. According to a study conducted by the Society for Maternal-Feral Medicine, children who were exposed to cocaine in utero are 2.4 times more likely to have language problems than children not exposed to cocaine. The outcome for babies with prenatal alcohol exposure depends on the extent of the damage to the fetus born with Fetal Alcohol Syndrome (FAS).

The drug-addicted mother's lifestyle is often characterized by inadequate or no prenatal care, poor nutrition, and prostitution, any or all of which may result in a high risk for medical and obstetrical complications. Needle use may result in infection with hepatitis B and HIV. Methadone-maintenance programs for heroin-addicted mothers generally offer medical and social services to help mitigate these negative influences and contribute to the improved outcome seen in their babies, despite a continuation of opioid drug addiction on their part.

Drug Withdrawal, in the absence of other problems, is now readily managed in hospitals. The outcome for addicted babies depends on any permanent medical sequelae as well as the quality of the postnatal environment. These babies often require ongoing medical, school, and social services to ensure that they reach their maximal potential.

(See also: Fetus, Effects of Drugs on ; Pregnancy and Drug Dependence )

BIBLIOGRAPHY

Chasnoff, I. J. (Ed.). (1988). Drugs, alcohol, pregnancy and parenting. Boston: Kluwer Academic Publishers.

Cook, P. Shannon, Petersen, R. C., & Moore, D.T. (1990). Alcohol, tobacco, and other drugs may harm the unborn. DHHS Publication no. (ADM)90-1711. Rockville, MD: U.S. Department of Health and Human Services.

Johnson, Kate. (2000). Prenatal Cigarette, Cocaine Exposure Tied to Language Problems. OB GYN News, 35, 13.

Lester, Barry. (2000). Drug-addicted Mothers Need Treatment, Not Punishment. Alcoholism & Drug Abuse Weekly, 12, 5.

Joyce F. Schneiderman

Revised by Sheila Dow