We have all seen the stories on television and online: infants struggling with a complex picture of symptoms including twitching, pain, seizures, diarrhea, abdominal cramps. These are babies born addicted to opioids (and sometimes other substances). Once a relatively rare occurrence, NICUs around the country are finding themselves overwhelmed with the numbers of babies born addicted and requiring long-term care to safely wean them off of opioids. When a mother uses drugs, whether for treatment of addiction or not, babies have a 55-95% chance of being born with NAS.
What is NAS?
If you read the title to this article and thought, "What's that?" you are not alone. NAS, or Neonatal Abstinence Syndrome, was first described by Finnegan in 1975 (Finnegan LP, Connaughton JF Jr, Kron RE, Emich JP). Neonatal abstinence syndrome: assessment and management. Addict Dis 1975;2:141-158). Since that time, the term has come into much more common use as the incidence of NAS, also known as Neonatal Drug Withdrawal Syndrome, has continued to rise dramatically. From 2000 to 2012, the rate increased by a factor of 5.
A complex picture, victims of Neonatal Drug Withdrawal are observed to suffer all the symptoms that adults suffer when in drug withdrawal including: fever, sweating, sneezing, tachypnea, projectile vomiting, weight loss, watery stools, excessive sucking, tremors, high-pitched crying, twitching, high muscle tone, etc. Additionally, the average length of stay in hospital for NAS babies is 17 days (Patrick SW, Davis MM, Lehmann CU, Lehman CU, Cooper WO). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. (J Perinatol 2015;35:650-655). Often, the sequelae continue after discharge, although it is unknown as yet what all the long term effects of being born with NAS are. It remains to be seen what their long term needs will be, but it is safe to say that they are starting off life with some additional challenges-as are their families.
So what are we to do as nurses observing a growing problem?
Ashlie Harrod, RN, works at the Sullivan County Health Department in East Tennessee. Her county has among the highest rates of NAS reported (although only 5 states currently report statistics on NAS). "The incidence in our area is so high because of a combination of lack of education regarding pregnancy prevention, and a high rate of drug abuse, among other socioeconomic problems." She goes on to say, "Contraception is not common sense." She spends her workdays leading classes in jails, health departments, halfway houses and at outpatient drug maintenance clinics-basically any place she can find men and women who will listen to her sage advice on all matters of pregnancy prevention.
While 45% of pregnancies are unintended in the general population, that number climbs steeply to 86% among addicts. Harrod attests to the general lack of knowledge about body functions, biology and specifically about the various methods of birth control. When she visits the various settings, she offers birth control pills, Depo Provera shots (3 months of contraception) as well as more long-term prevention, including long-acting IUDs, rings, patches and implants. Besides paving the way for implants and IUDs, she can also help get men set up for vasectomies-after careful screening. All services of the health department are offered free of charge.
"Our goal is a healthy community"
Harrod goes on to say that at the Health Department, "Our goal is a healthy community. We want to provide information, education, counseling, testing, whatever people need to do effective family planning." In addition to pregnancy prevention, the health department works hard to take care of women who are already pregnant, making sure they get what they need while pregnant and that they are connected with a variety of services that can help them when the baby is born.
If the baby has NAS, families often need early intervention and long-term assistance, using a care team approach. NAS babies are irritable, in pain, difficult to console. During this perinatal time of bonding and attachment to their parents, these infants and their families need a lot of extra help and attention.
Nurses always have a role to play. As professional health care providers, we are examples in the community. We can lead the way to finding out what is available in our area, helping to get that information out there and lending a hand through community networks. Maybe we will be the ones in the newborn nursery or the NICU, but we also might be the ones to learn first of an unintended pregnancy, or of a need for foster care. Whatever our situation, we will all be called on to answer and to serve in some way.
Harrod says, "This crisis is an opportunity for all of us to put our differences aside and to stand up for this next generation of children." The time is now. As professionals, let us band together to advocate for and help these tiny, innocent victims. What is your response?