Newborn drug testing

Cindy Running, mother and child clinical practice expert, displays an umbilical cord sample at UnityPoint Health -- St. Luke's in Sioux City. The hospital collects samples of umbilical cords from all babies born there and sends for testing those from babies suspected of being exposed to drugs. If not sent for testing, cords are destroyed after seven days.

SIOUX CITY -- A drug dependent baby may look just like any other newborn at birth.

However, Cindy Running, a clinical practice expert, who works in UnityPoint Heath -- St. Luke's neonatal intensive care unit, said the baby's high-pitched cries, sweaty skin, jittery behavior and poor eating habits indicate he or she has likely been exposed to drugs in the womb.

"They could be hospitalized for days to weeks, depending on the amount of exposure," she said of drug dependent babies.

Hospitals screen babies when risk factors of drug exposure are present, including maternal history of illegal drug use, no prenatal care, or prenatal care that is late or inconsistent. St. Luke's tests between 350 and 450 babies annually for drug exposure, according to Running, who said the hospital changed how it conducts infant drug screening last October.

Previously, Running said the meconium, or earliest stool, was tested. Now, the Sioux City hospital keeps a segment of every baby's umbilical cord for seven days. If drug screening is warranted, the segment can be tested for 13 different drugs rather than just nine.

"We weren't capturing Tramadol, which is a fairly common pain medication," said Running, who said buprenorphine, oxycodone and Demerol can also now be detected.

Newborn drug testing

Cindy Running, mother and child clinical practice expert, displays an umbilical cord sample at UnityPoint Health -- St. Luke's in Sioux City, Iowa. If a baby is suspected of being exposed to drugs, a segment of the umbilical cord can be tested for 13 different drugs.

Last year, St. Luke's tallied 72 infant drug exposures, up slightly from 70 in 2016. So far in 2018, 17 infant drug exposures have been recorded at the hospital.

In 2017, Running said 21 percent of babies that tested positive had more than one type of drug in their system, up from 16 percent in 2016. So far in 2018, she said that percentage is 30. Cannabis or marijuana is most commonly detected, followed by amphetamines, including methamphetamine. Cases of opioid exposure are "sporadic," according to Running.

Robert Bonebrake, a maternal-fetal medicine specialist at Methodist Women's Hospital in Omaha, cares for women with high-risk pregnancies, including women who are using drugs. He will speak about pregnant women who are addicted to opioids May 9 at St. Luke's during the annual Perinatal Conference.

Bonebrake said the majority of pregnant women he sees are using prescription opioids, rather than illegal opioids such as heroin. He said the use of prescription opioids may be "completely appropriate and necessary for chronic pain."

Whether mothers are using opioids legally or illegally, their babies can develop neonatal abstinence syndrome (NAS), withdrawal after exposure to certain drugs in the womb. Symptoms of NAS include irritability, poor suckling reflex, disrupted sleep patterns and high-pitched cries.

"Depending on what moms are on and what duration, they may have a rate of neonatal abstinence syndrome of up to between 30 and 80 percent, which is very significant," Bonebrake said. "The symptoms you'll probably see as early as three days, but it may be delayed up until a couple weeks out from birth."

Bonebrake said the generic drug buprenorphine, which is marketed under the brand name Subutex, is the treatment of choice for pregnant women who are addicted to opioids. Buprenorphine helps people reduce or quit using opioids by preventing withdrawal symptoms. It is less addictive than other opioids, such as heroin, morphine and oxycodone.

Bonebrake said the women remain on buprenorphine throughout their pregnancies and are followed closely with prenatal care. In Tennessee, he said doctors are offering controlled withdrawal during pregnancy. In the future, he said he thinks the latter method will be widely adopted.

"The big concern is always that you're putting stress on the kid and increasing the risk for adverse outcomes of pregnancy. What they've shown in Tennessee is that (withdrawal) can be done completely safely and well and without significant risk of relapse," he said. "You have to have a great system set up and all the support systems you need to do that."

Running said babies born dependent on opioids and other drugs are kept comfortable at St. Luke's in rooms that are dark, calm and quiet. 

"Sometimes, they're not really great eaters, so they need small frequent meals versus a baby that might go three or four hours in between a feeding," she said of these babies. "We just pay attention to the babies' cues and support them that way."

Running said baby cuddlers, adult volunteers who have undergone background checks and received training, are often called upon to sit in a chair and hold drug dependent babies when the babies' parents aren't available. The volunteers are encouraged to talk, read and sing to the babies while holding them.

"These babies need that more consistently than a healthy-term baby," she said. "Really what these babies need is continuous holding and cuddling. That's when they do the best."

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