Issue link: https://tmcpulse.uberflip.com/i/686754
t m c » p u l s e | j u n e 2 0 1 6 8 By Shanley Chien E arlier this year, the United States Centers for Disease Control and Prevention issued 12 new recommendations for prescribing opioid medications. The FDA followed closely on the heels of the CDC with an announcement of its own to implement enhanced safety warnings for prescription painkillers. While the CDC's guidelines and FDA's warnings serve as pivotal moments in the war on opioid abuse and the addiction epidemic sweeping the country's adult population, these new measures could also have a large impact on the tiniest of patients: babies. "[The CDC and the FDA's] policy is very import- ant because I think the use of prescription painkill- ers among mothers is one of the main reasons for neonatal abstinence syndrome (NAS). The thing that tugs at our hearts is that these babies go through a lot as soon they are born, through no fault of their own," said Krithika Lingappan, M.D., neonatologist at Texas Children's Hospital and assistant professor of pediatrics at Baylor College of Medicine. "I think, from a parental per- spective, from a caregivers' perspective and from a financial perspective, this is a huge deal." NAS is a condition characterized by a variety of problems in newborn babies and results from a sudden withdrawal of addictive opiate drugs after prolonged exposure in the mother's womb. As the pregnant mother introduces substances into her system, those drugs pass through the placenta and to the baby, leading to addiction. According to a 2015 analysis by the National Institute on Drug Abuse, the number of babies born with NAS increased five times between 2000 and 2012, during which time an estimated 21,732 babies were affected by opioid withdrawal. The prevalence is equivalent to one baby being born with NAS every 25 minutes. "They go through symptoms of withdrawal, which are very difficult for parents to see, but it's also heartbreaking for the caregivers," Lingappan said. "These babies are very difficult to calm and often cry inconsolably. Even though our nurses do a very good job of swaddling and comforting them, that's often not enough. "Close maternal involvement can, in many cases, obviate the need for pharmacological therapy," Lingappan added. "We are very proactive about starting the treatment when needed before the symptoms of withdrawal get very severe, but at the same time, we try our best to do whatever we can to prevent giving pharmacological therapy to the baby, which in most cases is an opioid agent like morphine or methadone." When non-pharmacological approaches—such as the mother holding, rocking, engaging in kanga- roo (skin-to-skin) care and breastfeeding—are insuf- ficient for soothing the baby, doctors refer to the Finnegan NAS scoring system, which is designed to help nurses and doctors determine the severity of NAS and initiate therapies for babies experienc- ing severe symptoms. The caregivers administer small dosages of morphine to help alleviate NAS symptoms, enough for the baby to continue with his or her normal development and growth. "Basically, [going cold turkey in a baby with severe NAS has] all the signs that you would see S E C O N D I N A T H R E E- PA R T S E R I E S O N O P I O I D A D D I C T I O N WHILE THE OPIOID ADDICTION EPIDEMIC AFFECTS A LARGE POPULATION OF ADULTS, BABIES BORN TO MOTHERS USING OR ABUSING PRESCRIPTION PAINKILLERS NEED HELP RECOVERING AS WELL A d i DCtE B E F O R E B I R T H d ACCORDING TO A 2015 ANALYSIS BY THE NATIONAL INSTITUTE ON DRUG ABUSE, THE NUMBER OF BABIES BORN WITH NEONATAL ABSTINENCE SYNDROME INCREASED FIVE TIMES BETWEEN 2000 AND 2012, DURING WHICH TIME AN ESTIMATED 21,732 BABIES WERE AFFECTED BY OPIOID WITHDRAWAL.