Three weeks premature, Baby Jessica entered the world weighing only 4 lbs. 12 ounces. Crying inconsolably in the NICU, she experienced tremors, blisters, and severe reflux.
Even worse, she was unable to breathe without assistance. She also had a congenital heart defect. The diagnosis: Neonatal Abstinence Syndrome (NAS). The cause: opioids.
Long before COVID-19 reached the shores of the United States, the opioid epidemic exposed deep inequities in our society that had been raging for years. In 2017, an estimated 11 million people misused opioids in the United States at a cumulative cost of $1 trillion from 2001 to 2017.[1] While news stories focused on the tens of thousands[2] dying from opioid overdoses each year, another population segment also suffered the impact – the unborn.
The story of baby Jessica plays out 20,000 times per year. That’s how many infants are estimated to be born with NAS each year.
What’s more, the COVID-19 and opioid epidemics have become intertwined. According to a September 2020 analysis of electronic medical records, hospital patients diagnosed with opioid use disorder in the past year were 10.2 times more likely to contract COVID-19.[3]
What is NAS and NOWS?
Unlike AIDS or COVID-19, NAS is not a disease you “catch.” Neonatal abstinence syndrome is a group of conditions caused when an infant withdraws from drug exposure in the womb – most often when a woman takes opioids during pregnancy. Neonatal Opioid Withdrawal Syndrome (NOWS) is the terminology used when withdrawal is due solely to opioid use. While COVID-19 has captured the nation’s attention with nearly 1 million deaths (as of May, 2022), the opioid crisis is not going away. From 1999–2019, nearly 500,000 people died from an opioid overdose.[4]
Managing NAS/NOWS at ProgenyHealth
When Jessica was finally able to leave the hospital, her foster mom took her home, unsure how to care for her complex and demanding needs. Fortunately, ProgenyHealth case managers could help the foster mom manage Jessica’s difficulties with feeding, sleeping, and tremors.
NAS Awareness Month
Jessica is a composite of the NAS cases we manage every day. October is Neonatal Abstinence Syndrome Awareness Month, so please take this moment to become aware of the magnitude of the crisis:[5]
- In 2019, 7% of women reported using opioid pain relievers during their pregnancy
- Of those women, 1 in 5 reported misusing those opioids
- Between 2010 and 2017, the number of infants born with NAS increased by 82%. This increase was uniform across all states and demographics
- The cost of a hospital stay in 2017 for an infant born with NAS was over eight times the cost of a typical infant
- The average length of stay in 2017 for an infant born with NAS was 11 days, as compared to 2 days for a typical infant
These numbers are just the tip of a public health iceberg. An increase in unemployment[6] coupled with a surge of loneliness and depression[7] has driven a stunning rise in opioid misuse.[8]
A Skyrocketing Epidemic
The opioid epidemic refers to the growing number of deaths and hospitalizations from prescription and illicit opioids – a death rate that has skyrocketed to over 50,000 a year.[9] Drug overdose is now the leading cause of accidental death in the United States.
Graph Courtesy of The Centers for Disease Control and Prevention
Common Prescriptions
Opioids mimic the effect of the original source – opium – but now are prescribed as a long list of pain relievers like the semi-synthetic OxyContin® and Vicodin® and dangerous street drugs like heroin.
When adults withdraw from opioids, we understand that withdrawal symptoms follow. The less-known fact is that infants who are born dependent on drugs have horrible withdrawal symptoms, too. The difference is that they are defenseless.
Opioid abuse is not just a problem of street drugs and struggling addicts. In many cases, a mother might take prescription medicine for chronic migraine headaches or back pain, not realizing that it may result in her infant undergoing withdrawal.
Drug Withdrawal in Newborns
When an infant is born and the cord is cut, the newborn’s opioid supply is gone, and the infant begins to have signs of physical withdrawal after a few days. The consoling responses a NICU nurse or a mom might give initially - feeding, diapering, holding – don’t always work. Despite these efforts to console, the infant will cry through the withdrawal. Sometimes, the newborn is given teeny drops of an opioid to calm the opiate receptors in the brain.
Groundbreaking NAS Work
Dr. Linda Genen, Chief Medical Officer (CMO) at ProgenyHealth, has been spearheading our work in managing care for infants born with NAS:
“NAS touches so many clinical areas,” Dr. Genen explained. “As one example, we are challenged even to classify NAS using appropriate ICD-10 codes. Additionally, there are the variations in care in treating NAS. This includes variations in toxicology screening, initial comfort care measures, medication-assisted treatment, fortified nutrition, and counseling.[10]
“The Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW) is studying NAS infants across 30 research hospitals to identify the variations in the care for these infants.
“The ultimate solution will be to develop new methods for pain relief that don’t require addictive drugs. The HEAL initiative is looking into non-opioid treatments for neuropathic pain, including chronic pain and migraine, inflammatory pain, and visceral pain.”
To learn more, click here for additional NAS-related blog content.
[1] https://altarum.org/news/economic-toll-opioid-crisis-us-exceeded-1-trillion-2001
[2] https://www.cdc.gov/drugoverdose/deaths/index.html
[3] https://www.ihs.gov/opioids/covid19/
[4] https://www.cdc.gov/opioids/basics/epidemic.html
[5] https://www.cdc.gov/pregnancy/opioids/data.html
[9] https://www.cdc.gov/opioids/basics/epidemic.html
[10] https://pediatrics.aappublications.org/content/147/1/e2020008839
