MONDAY, Jan. 30 (HealthDay News) -- A dramatic rise in newborns
experiencing drug withdrawal after being exposed in the womb poses
challenges for clinicians on how to detox these tiny victims, a new
The American Academy of Pediatrics (AAP) has released its first
updated guidelines on neonatal drug withdrawal since 1998, partly
in response to the escalating abuse of both illicit and
prescription drugs by pregnant women and partly in recognition of
better pain management techniques for babies who are critically
"There have been pockets of the country where up to 25 percent of all NICU [neonatal intensive care unit] babies at any given time are being treated for withdrawal," said report co-author Dr. Mark Hudak, a professor of pediatrics at the University of Florida College of Medicine in Jacksonville. "The problem has percolated up and reached the attention of government and medical officials."
The report is published online Jan. 30 in advance of appearing
in the February issue of the journal
Major drugs of abuse include prescription painkillers such as
oxycodone, codeine, morphine and methadone, the report noted, along
with stimulants such as amphetamines and cocaine and central
nervous system depressants such as marijuana, alcohol and
Exposure during pregnancy is linked to a host of problems among
newborns, including drug withdrawal upon birth -- demonstrated by
irritability, poor sucking, tremors, seizures, diarrhea, vomiting
and shrill crying -- and long-term issues such as birth defects,
impaired growth and behavioral problems.
The report recommended that each hospital nursery develop a
system to screen mothers for drug abuse, while confirming exposure
in newborns -- though not fail-proof -- usually entails taking
samples of the infants' urine and meconium (their first stool).
Some drug-exposed infants don't exhibit any problems after
birth, but first-line treatment for those who do includes comfort
measures such as minimizing light and sound, swaddling and rocking,
and offering high-calorie formula to minimize hunger. If those
measures aren't effective, babies may need to be treated with
therapeutic drugs to counteract the effects of the other drugs, the
"There are a lot of unknowns, but it's very important that they're focusing on this problem and bringing it to everybody's attention," said Dr. Dagmar Liepa, medical director of the inpatient medical detoxification unit at Mission Community Hospital in Panorama City, Calif. "The fact is that these babies are hurting, and have to be in the hospital longer and monitored longer. We don't know what the long-term effects will be."
Hudak said the paper adds information about the effects of
maternal antidepressant use, whose effects weren't as clear 14
years ago. It also discusses how to manage pain in newborns that
require surgery or other painful treatments, which is better
understood since the previous guidelines were issued.
"We need to provide these babies with enough [medication] that they don't feel any pain," he said, "but the flip side is if we treat babies with narcotic painkillers for a long time, they are at a high risk of being addicted."
The report is a "significant expansion" of the AAP's previous
guidelines and also points to where further research in the field
is needed, Hudak said.
"I think a lot of additional work needs to be done," he said. "It's state-of-the-art information -- right now."
Emory University has more details
newborn drug withdrawal.
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