University-backed study finds that babies born exposed to hard drugs rising rapidly 

  • Concord Hospital addiction specialist Molly Rossignol answers questions from the audience during Science Cafe at The Draft Sports Bar in Concord on Tuesday, Jan. 12, 2016. The panel theme was heroin and addiction. ELIZABETH FRANTZ

Monitor staff
Tuesday, December 19, 2017

When Dr. Molly Rossignol began delivering babies at Concord Hospital in 2000, she didn’t see many cases of infants born exposed to hard drugs in the womb.

Neonatal abstinence syndrome, a condition affecting newborns whose mothers misuse substances during pregnancy, wasn’t a staple of the family doctor’s medical vocabulary.

“It was rare to none that I ever saw a case of neonatal abstinence syndrome,” Rossignol said. “We weren’t familiar with it – as medical professionals, it didn’t ever really cross our minds.”

Even 10 years ago, if doctors noticed a newborn crying erratically, they might have concluded that the baby’s mother smoked cigarettes during pregnancy, or took another prescription medication, like antidepressants, Rossignol said.

Drugs like heroin and methamphetamine were not on doctor’s radars – a drastic change from today, when babies born in contact with opioids and other hard drugs are on the rise in New Hampshire.

A report released Tuesday from the University of New Hampshire and New Futures Kids Count found the number of infants diagnosed with NAS in the state has gone from 52 in 2005 to 269 in 2015 – a fivefold increase.

“I expected to see a rise in neonatal abstinence syndrome because I’ve heard in the news about the rise in opioid use and opioid drug deaths,” said Kristin Smith, a family demographer at the Carsey School of Public Policy at UNH, and the report’s author.

“However, these numbers are very striking,” she said. “What I’m trying to do is shine a spotlight on the multiple consequences of the epidemic in New Hampshire.”

Babies with NAS are essentially born in withdrawal – they suffer tremors, rashes, sleep deprivation and seizures, among other symptoms, said Director of Concord Hospital’s Family Place Erin Collins.

“Many of the symptoms mimic normal newborn behaviors: babies are fussy at times, they want to eat or be held,” Collins ​​​​​said. “The difference is, with NAS babies, those symptoms don’t stop even after needs are met.”

Not every baby exposed to drugs in the womb will develop NAS, Collins said. So far this year, Concord Hospital has processed 84 cases of babies born exposed to drugs – only 12 of which ended up being diagnosed with NAS.

Babies at risk of NAS are typically kept at the hospital in the special care nursery for at least 96 hours of observation, Collins said. During those 96 hours, nurses use a scoring system to judge babies’ symptoms, which can develop at different rates depending on what mixture of substances a mother might have been taking.

Nicotine and short-acting substances will typically provoke symptoms faster, for example, while other drugs, like opioids, might take longer, Collins said. 

NAS babies have historically been treated with morphine, but many New Hampshire clinicians, like those at Concord Hospital, are seeking alternative approaches to caring for drug-exposed babies, such as skin-to-skin contact, reiki, aroma therapy and music therapy, which are proving effective.

According to the study released Tuesday, babies diagnosed with NAS remained in the hospital for 12 days on average, compared to three days for other newborns.

But a safe experience for mothers and babies at risk of NAS extends much further than just the days immediately following a birth, Collins said.

Concord Hospital offers free care and support up to a year after delivery for parents and extended family through their emotional support counselor position.

Comprehensive prenatal care and planning is also essential to keeping mothers and babies healthy, Collins said.

Rossignol is now an addiction specialist at Concord Hospital, who works with mothers struggling with substance misuse. Women are typically screened for drug use at each trimester of their pregnancy, she said. Those who test positive for drug use are sent to her.

One way to help mothers struggling with addiction is by prescribing maintenance drugs like methadone or buprenorphine, Rossignol said. These drugs are prescription opioids that reduce cravings for heroin and fentanyl and stave off the sickness that comes from opioid withdrawal.

Rossignol said these maintenance drugs can be a great option to pregnant women with substance use disorders, a chronic relapsing illness that’s difficult to quit cold turkey, even with a child on the way, Rossignol said.

“Even when people make a self determination they are not going to use a substance, addiction is a brain disease,” she said. “It’s very hard to fight.”

A relapse could put a woman’s life – and her unborn child’s – at risk, Rossignol said.

Maintenance drugs have been proven to markedly reduce the risk of overdoses and the development of neonatal abstinence syndrome, Rossignol said.

Rossignol said the mothers she works with are typically honest about their experiences with drugs – and want to do what it takes to provide for their children any way they can.

“I have not met a single mother who did not want to do what’s best for her baby,” she said.

New Hampshire has been one of the states hardest hit by the drug crisis, with the skyrocketing numbers of opioid overdoses blamed on liberal prescription practices, underfunded and scarce treatment options and the state’s proximity to the drug supply chain.

The state’s death rate due to synthetic opioids, mainly fentanyl, increased by nearly 1,600 percent from 2010 to 2015 and only now is starting to level off. This year, the state estimates there will be 466 overdose deaths – slightly lower than the 485 in 2016.

(The Associated Press contributed to this report. Leah Willingham can be reached at 369-3322, lwillingham@cmonitor.com or on Twitter @LeahMWillingh  am.)