The increasing numbers of women who abuse prescription painkillers while pregnant are delivering the crack babies of the 21st century, specialists say.
As drug abuse in this country has shifted from street drugs toward the medicine cabinet, more children enter the world dependent on their mothers' prescription painkillers, like OxyContin, Vicodin and Percocet. Baby nurses who once monitored rows of cribs with cooing newborns today are on alert for irritable newborns who may cry excessively, or develop tremors, diarrhea, sweating and vomiting in their first hours to days of life -- all signs of withdrawal from drugs they absorbed from their mother's bodies.
"You walk into the nursery, and you can hear these kids screaming. This is a high-pitched, angry, sort of pained cry," said Dr. Jonathan R. Wispe, a neonatologist at Nationwide Children's Hospital in Columbus, Ohio, who estimated that at any given moment, there were probably three to four such children in a unit that's kept quiet, dark and calm just for them. "They're rigid and tense. They look like miserable things."
Wispe belongs to a coalition of Columbus-area hospitals that track these births. "We've probably seen a tripling or quadrupling of opiate-addicted babies," from 2005 to 2010, the last year for which they have statistics, he said. In 2010, 56 babies at his hospital and more than 200 in Columbus were born hooked on their mothers' prescription narcotics.
"Two-thirds of the time at least," the mothers don't reveal their drug-using history, he estimated.
As a result, doctors must be vigilant about possible in-utero drug exposure, which may begin to cause symptoms within hours to days of delivery, depending on the mother's patterns of usage, several doctors said. Generally, it crops up within two to three days, Wispe said. "They get very jittery and very cranky. Initially, feeding them helps."
"When the kid withdraws depends on when Mom takes her last dose, and how used to it she is," Wispe said. "If Mom is a chronic user, then babies are badly addicted."
Treatment generally consists of a hair-of-the-dog approach. To relieve pain and agitation, doctors administer small doses of morphine or methadone, sometimes adding clonidine, a blood pressure drug, to lower the heart rate. Once they have the babies stabilized, they can begin the painstaking process of gradually tapering the drugs until they're pain-free and able to function again. Babies born hooked can spend up to six weeks in the hospital before they're ready to go home.
"The tried-and-true at this point is morphine," said Dr. Walter Kraft, director of the Clinical Research Unit at Thomas Jefferson University in Philadelphia. He explained that because morphine is a short-acting drug, it's easier to control the dosage for a tiny baby. But he and several colleagues wondered if buprenorphine, a longer-acting drug that has eased withdrawal for adult opiate addicts without being tied to daily visits to a methadone clinic, could be used in newborns soon after delivery.
Because the drug is a pill placed under the tongue, "the challenge was: Are they going to swallow it, spit it out?" he recalled. Doctors created a liquid version, put it under the newborns' tongues "and immediately put in a pacifier. At the end of the day, it ended up working."