WV pediatrician proposes new treatment, approach for decreasing number of drug-dependent newborns

Apr 21, 2018

West Virginia has been one of the hardest-hit states in the opioid epidemic, especially when it comes to neonatal abstinence syndrome -- a condition where addicted mothers give birth to drug-exposed babies.

"Take Care" spoke with Dr. Sean Loudin, pediatrician and neonatologist at Cabell Huntington Hospital in West Virginia and assistant professor at the Joan C. Edwards School of Medicine at Marshall University, regarding his research and efforts surrounding treating this growing problem.

Loudin, who is also the medical director of Lily’s Place, the first neonatal abstinence syndrome center in the U.S., said for as long as women have misused substances, babies have been born with drug dependency. However, he said this problem has recently increased significantly in the state.

According to Loudin, recent estimates have shown that about 5.2 percent of babies born in West Virginia have neonatal abstinence syndrome.

“We as a state recognize that we do have a problem, and so we’ve been very proactive in our approach to how we want to identify babies [with this condition],” Loudin said.

The opioid epidemic has led to newborns with neonatal abstinence syndrome to experience a very specific type of brain adaptation that can be worse than exposure to other drugs.

“The baby’s brain undergoes changes over those few months inside a mom that…when that baby’s born, there’s just a flood of adrenaline that goes through their body,” Loudin said. “That is what neonatal withdrawal is -- the baby’s body reacting to its own adrenaline release.”

He says this can result in excessive crying, tremors, fever and other repetitive behaviors that make the baby feel uncomfortable.

Despite this reaction, Loudin doesn't refer to babies as “born addicted.” Adults can exhibit conscious behaviors that cause an addiction, whereas babies do not have this ability and can therefore not technically be addicted, according to Loudin.

“Because of the exposure, [babies] do have certain dependence after they’re born, but they don’t exhibit necessarily behavior,” Loudin said.

This issue with neonatal abstinence syndrome has led to physicians like Loudin changing their approach to match the change in research and the drugs being used by pregnant women.

"Mothers help babies; babies help mothers. They both help each other's recovery, and so that is a big focus on what we do medically now."

Usually, it will take about a month to treat a baby who was exposed to opiates, Loudin said. This time can lengthen if the baby is exposed to more drugs. 

“The problem becomes when babies are exposed to multiple different medications and multiple different classes of drugs,” Loudin said. “It makes their withdrawal much more complex.”

This complexity can involve a brief, very acute phase of withdrawal and then a subacute phase that lasts for months. Babies who are exposed to multiple drugs can suffer behavioral or mental issues later in life as a result as well, Loudin said.

The rising problem has led to a surge in adoption system intakes in the state and an increased responsibility on Child Protective Services to handle the worsening situation.

“Somebody who is in the throes of addiction may unfortunately choose that addiction over their own child,” Loudin said. “In those circumstances, obviously, that child is not safe.”

In those cases, the child will have to be removed for their own safety. However, Loudin said in the majority of cases, the new mothers are seeking as much treatment as possible to fully recover and take care of their child.

Because of this, Loudin said it is imperative to stress the relationship between the newborn and mother.

“Mothers help babies; babies help mothers,” Loudin said. “They both help each other’s recovery, and so that is a big focus on what we do medically now as well, too. We work to be able to keep mothers and babies together.”

In addition to these changes, Loudin said he would like to see measures taken both inside and outside the medical field to tackle this growing problem. These include focusing on education efforts and destigmatization. 

“We need people to seek treatment,” Loudin said. “We also need people to understand that just because their neighbor or their friend or their cousin or whoever may have a problem doesn’t mean they’re a horrible person.”

He said increasing the number of providers, counselors and physicians to aid in recovery and treatment would benefit both mothers and newborns. Outside of hospitals, Loudin focused on a macro, sociological solution to eliminate the situations that can lead to these conditions in the first place.

“We need people to have motivation,” Loudin said. “We need to decrease the amount of hopelessness that people feel in general because then that way, they won’t want to escape their reality; they run toward their reality.”