Opioid use is a growing crisis in the United States, and according to recent statistics released by the Pennsylvania Health Care Cost Containment Council, or PHC4, the issue is becoming serious in its impact on the youngest residents of the state — Pennsylvania’s newborns.
A recently released report from PHC4 indicated that the rate of newborns who are born with symptoms of withdrawal due to substance abuse by their mother has increased 1,000-percent since 2000.
In the 2000-2001 fiscal year, the rate of newborns across the state of Pennsylvania who were diagnosed with Neonatal Abstinence Syndrome, or withdrawal issues related to a mother’s illegal substance abuse, was 1.2 newborns for every 1,000 recorded newborn hospital stays. By 2016-2017, that rate had increased to 15.0 newborns with NAS per every 1,000 newborn hospital stays.
Dr. Mohamed Hassan, Penn Hills DuBois medical director of the Neonatal Intensive Care Unit (NICU), explained how serious these problems can be.
“For these babies, it is not just the problem of NAS. They also will have other complications from drug abuse of the mother during pregnancy, including low birth weight, which is defined as below 2500 grams; prematurity; increased risk of feeding difficulty, and sometimes respiratory problems,” Hassan said. “There is 3 to 4 times more risk for these complications than for a normal newborn, which means a longer stay in the hospital, which means more money.”
The newborn’s stay in the hospital at birth is extended from the average three days to as long as three weeks to allow complete treatment for NAS and related conditions. The release from PCH4, issued March 28, read, “The average hospital stay for newborns with NAS was 17.1 days compared to 3.5 days for all other newborn stays. This difference accounted for an additional 26,018 days in the hospital for babies with NAS.”
Those extended stays mean a greater cost as well, leading to an estimated $14.1 million in hospital payments for newborns with NAS in the 2016-2017 fiscal year.
The council report broke down the number of newborns with NAS by income, finding that the rate for white, non-hispanic newborns in Pennsylvania was 19.5, while the rate for non-hispanic, black newborns was only 7.2 Meanwhile, the rate of newborns with NAS born into households with a median income of $40,000-50,000 was 19.2, while the rates for both under $40,000 and $50,000-60,000 were closer to 16, at 16.7 and 16.4, respectively.
Meanwhile, the rates varied drastically by county. The highest rate was 76.0 per 1,000 newborn stays, which was recorded in Green County. According to the council’s report, during the 2016-2017 fiscal year, the rate of newborns with NAS in McKean County was 24.4, while the rate for Elk County was 45.1 per 1,000 newborn stays.
“We are the only NICU in a 150-mile radius, so we get babies from Bradford, St Marys, Ridgway and Coudersport,” Hassan said. “The next closest NICU would be Pittsburgh or Geisinger.”
One important factor to note with NAS is that not every baby born to a mother who uses drugs will have the condition. Roughly 60-percent of the babies born to mothers who showed signs of substance abuse in Pennsylvania in 2017 were found to suffer from NAS. There were 3,289 mothers in the state recorded with evidence of substance abuse; of those 1,912 newborns were diagnosed with NAS.
“The baby will be transferred only if they need treatment (for NAS),” Hassan explained. “The way we know if they need to be treated is that most babies will have signs of withdrawal in their first five to seven days of life. If the baby is born to a mother who was using illegal substances, we start to monitor the baby for withdrawal signs.”
Hassan explained that if the baby is born in Bradford, the baby stays in Bradford and is monitored in the hospital there until it is certain that the baby suffers from NAS and there are signs of withdrawal that are significant enough to be treated. Then, the baby is transferred to the NICU in DuBois.
Hassan said for now, the number of newborns with NAS remains within a treatable ratio to the other patients in the NICU. However, plans are underway if the needs change and the condition rates continue to increase as they have been.
“In other NICUs, for example in Pittsburgh, they have started to create separate wards for these babies,” Hassan said. “If a problem like this continues to increase, at a certain time we can designate a certain area or unit. Right now they are treated in the NICU in general, and it is not necessary to do that at this point.”
Meanwhile, the process of education and treatment begins well before the newborn enters the world and spends time in the NICU.
“This is a multi-disciplinary program; we work to take care of the problem even before delivery,” Hassan said. “Personally, as a neonatologist, I have made many, many visits to methadone clinics to offer outreach education for moms. We have done outreach to schools — high and middle school to teach kids about this.
“We also offer prenatal consultations. I meet with mother or parents, as sometimes the father is also involved; I explain protocols that we use and how the baby will be monitored and treated. We warn them that on average, it takes three to four weeks for the baby to be treated for drug withdrawal. This way, they can be aware of what is coming, so it is not a surprise for them.”
Once the baby arrives and shows signs of NAS, the treatment begins and programs are put into play for the parents as well.
“While the baby is here, we work with parents daily to provide education for dealing with the babies at home, we offer social programs to help them and hopefully convince them to get off the drugs,” Hassan stated.
Despite the efforts in place, this situation will need more attention as time goes on. Hassan noted the problem may need more attention than it currently gets in order to have hope to find resolution.
“This is a growing problem and a national crisis,” he warned. “We are going to need the help of all kinds of authorities and society; the government, hospitals, physicians and communities — to fight this.”
