Evidence of drug use in mothers of babies with NAS -- but also in control group mothers

September 15, 2017

CHICAGO - Researchers conducting a study of newborns experiencing symptoms of drug withdrawal knew the infants' mothers would test positive for substance use. But in the course of their study they had another, surprising finding: They discovered that 1 in 4 women enrolled in the "drug-free" comparison group, whose infants were not diagnosed with neonatal abstinence syndrome (NAS), also tested positive for illicit drug use.

The study abstract, "Infants with Neonatal Abstinence Syndrome and Their Drug Dependent Mothers Compared to Matched Controls: We have a drug problem," will be presented on Friday, Sept. 15, at the American Academy of Pediatrics 2017 National Conference & Exhibition in Chicago.

Researchers at Hutzel Women's Hospital, Detroit, Michigan reviewed the medical charts of infants born with symptoms of drug withdrawal from November 2011 to December 2016. For a control group, they also reviewed the charts of babies born right before and after each of the babies diagnosed with NAS. In total, they analyzed data for 222 babies with NAS and 490 without.

Not unexpectedly, the researchers found that 100 percent of the mothers of infants with NAS tested positive for substance use, said Pallavi Karunakaran, MD, an author of the abstract and pediatric resident at Children's Hospital of Michigan. Of these women, 81 percent tested positive for using opioid medications (including methadone, commonly used to treat opioid addiction, among 70 percent of them). In addition, these mothers also tested positive for heroin (42 percent), cocaine (29 percent) and marijuana (26 percent), as well as other substances.

"Alarmingly, however, more than 26 percent of mothers in the control group also tested positive for substance use," Karunakaran said. In this group, the most common drugs detected were marijuana (20 percent), opioids (4 percent), and cocaine (1.2 percent).

The study found that infants born to drug dependent mothers who developed neonatal abstinence syndrome had an earlier gestational age, lower birth weight, and longer hospital stay. Nearly 60 percent of the babies with neonatal abstinence syndrome were male, and 80 percent of them were Caucasian.

The researchers said the findings suggest a substantial number of pregnant women are not accessing drug addiction treatment, placing their babies' health at risk from prenatal exposure.

"We are faced with a national drug problem of epidemic proportions and pediatricians care for some of its unwitting victims - the vulnerable newborn," said Eugene Cepeda, MD, another author of the abstract and pediatric and a neonatal-perinatal pediatrician at the hospital. "We need to be vigilant, compassionate, and effective in our management of the infant and recognize that many women regardless of race, age, and economic status can be affected by this growing drug epidemic," he said.
Dr. Karunakaran will present the abstract, available below, on Friday, Sept. 15, between 6 p.m. and 8 p.m. at the Marriott Marquis Chicago, in the Great Lakes A-D meeting space.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Abstract Title: Infants with Neonatal Abstinence Syndrome and Their Drug Dependent Mothers Compared to Matched Controls: We have a drug problem

Purpose: To compare infants with neonatal abstinence syndrome (NAS) and their drug dependent mothers to a control group at a single women's hospital between the years 2011-2016. Methods: Chart review was performed on infants with NAS and matched with controls at Hutzel Women's Hospital, Detroit, Michigan from November 2011 to December 2016. Infants were diagnosed with NAS using the modified Finnegan scoring system, maternal history, urine and meconium drug screens. A matched control was identified as the two newborns delivered before and after the birth of each NAS infant. Maternal data was abstracted from charts linked to neonatal records. Maternal and infant characteristics were analyzed, including birth information, maternal drug use, infant withdrawal, and length of hospital stay. Means, standard deviations, and percentages were determined. A p-value < 0.05 was considered significant. Results: A total of 750 infant charts were abstracted: NAS infants numbered 250; controls 500. Data was available for 712 infants: 222 NAS infants and 490 controls. Only 198 maternal charts were linked to NAS infants and 490 to control infants. Mean maternal age was 28 ± 4.9 years for NAS mothers and 26 ± 5.8 years for control mothers (p < 0.001). All mothers of NAS infants had substance use; however, 26.7% of control mothers were positive for illicit drugs. Among NAS mothers, drug use included opioids 80.9% (including methadone 70.4%), heroin 41.9%, cocaine 29.1%, marijuana 26.1%, benzodiazepines 18.2%, buprenorphine 6%, and barbiturates 1.5%. Among the control mothers, drug use included marijuana 20.4%, opioids 1.8%, cocaine 1.2%, benzodiazepines 0.6%, heroin 0.2%, and barbiturates 0.2%. More males were present among the NAS infants (58.6%), than in the control cohort (49%), p=0.019. Among the NAS infants, 79.5% were Caucasian, and among controls, 88.8% were African-American. Mean gestational age for NAS infants was 38.0 ± 1.9 weeks vs. 39.0 ± 1.5 weeks in controls (p < 0.001). Mean birth weight for NAS infants was 2930 ± 537 grams vs. 3145 ± 490 grams in controls (p=0.018). The average length of hospital stay was 21 ± 10 days for NAS infants and 3 ± 1 days for control infants (p < 0.001). Mean Apgar scores were not significant between the groups. Conclusion: Infants born to drug dependent mothers who developed NAS had an earlier gestational age, lower birth weight, and longer hospital stay. NAS mothers tested positive for additional drugs besides methadone. Alarmingly, 26% of control mothers were positive for illicit drugs.

American Academy of Pediatrics

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