Health UnityPoint Health-St, Luke's neonatal intensive care

Nurse Jill Cunard cares for a newborn in the neonatal intensive care unit at UnityPoint Health-St. Luke's. Infants born drug dependent can suffer withdrawal symptoms that include high-pitched crying, seizures, diarrhea and trouble sucking and swallowing.

SIOUX CITY | Cindy Running said sometimes it takes drug dependent babies hours to get comfortable.

These infants suffer withdrawal symptoms that include high-pitched crying, seizures, diarrhea and trouble sucking and swallowing.

"Most babies you pick up and swaddle and they just look at you and they're perfectly happy," said Running, a clinical practice expert, who works in UnityPoint Heath-St. Luke's neonatal intensive care unit. "Sometimes no matter what you do, they cry for a long time."

The number of babies born exposed to drugs in Woodbury County has more than doubled from 2014 to 2015, according to data from Siouxland CARES, a community coalition whose mission is to improve the quality of life in Siouxland by eliminating the abuse of alcohol and other drugs.

Sioux City hospitals tallied 86 infant drug exposures in 2015, up from 42 the year before. The number of exposures in Woodbury County has been on the rise since 2013. Hospitals test mothers and babies when risk factors are present, including maternal history of illegal drug use, no prenatal care or prenatal care that is late or inconsistent.

In 2015, 52 tests confirmed the presence of marijuana, while 20 detected amphetamine and seven the presence of opiates. Four tests were positive for marijuana and amphetamine and one detected methadone. The other two positive tests involved combinations of cannabinoids, methamphetamine, opiates and amphetamine.

"It's exploded, primarily due to marijuana," Siouxland CARES executive director Linda Phillips said of the increase. "People are addicted to either marijuana or other drugs. It's attitudes that if states are legalizing (marijuana), it must be OK."

Heroin abuse has surged in eastern Iowa. Phillips said it's only a matter of time before the epidemic hits Siouxland, that's why she said Siouxland CARES is launching a campaign to raise awareness of the dangers associated with prenatal drug exposure.

"'Why would a woman do this?' Because they're addicted,'" she said. "We need to help them and help their babies."

Nathan Gollehon, a pediatrician at Children's Hospital & Medical Center in Omaha, said neonatal abstinence syndrome (NAS) -- withdrawal after exposure to certain drugs in the womb -- isn't always the result of illicit drug use. Gollehon, who will speak about drug dependent babies May 11 at St. Luke's annual Perinatal Conference, said opioids are causing the majority of cases of NAS nationally.

Prescription painkillers such as morphine, methadone, hydrocodone and oxycodone are opioids, as is the illegal drug heroin.

"A lot of times it's not something the mom was doing wrong. She was prescribed a pain medication because she had kidney stones or for some other reason," Gollehon said. "She wasn't doing this intending harm to her baby."

Physicians with pregnant patients need to be aware of the effects prescription opioid medications can have on a developing fetus, he said. If there are alternative drugs that are safe for the mother and are less likely to harm the baby, he said those medications should be considered first.

The estimated total number of opioid analgesic prescriptions in the United States increased by 104 percent, from 43.8 million in 2000 to 89.2 million in 2010, according to a study published in Regional Anesthesia and Pain Medicine in January 2014.

NAS financially burdens the health care system. Gollehon said the average baby diagnosed with NAS is hospitalized for more than two weeks. Babies needing medications such as morphine and methadone, which are commonly used to treat opioid dependence, spend 22 or 23 days in the hospital racking up $90,000 in costs on average.

"About 80 percent of the costs are being covered by Medicaid, so it's not just the cost for the hospital or the families. It's a cost that all of us are paying, too," he said.

If a drug dependent baby's withdrawal symptoms aren't severe, Gollehon said environmental treatments can offer relief. These babies can find comfort in a room that is dark and quiet. They can be calmed with swaddling.

"There's a good chunk of babies that will respond to those sorts of things and not even need medications," he said. "They may end up needing to stay in the hospital longer than a typical baby, but sometimes those simple things are enough to get them through."

Phillips said she is concerned about babies leaving the hospital and going home to a household were drugs are being used. She said women sometimes stop using drugs before they go to the hospital to deliver, especially if they have a C-section scheduled. If a mother stops using drugs before giving birth, Phillips said the drugs might not be detectable in her or her baby's system.

Running said withdrawal symptoms could hit the baby immediately after delivery or three or four days later. She said you never know how severe the withdrawal symptoms might be.

"I've been doing this for 26 years and I've seen babies in the hospital for two or three months just to come off of their withdrawals, especially if they've been exposed to it throughout the whole pregnancy," she said.

"Are we going to see it with one hit of marijuana? Probably not. But with that prolonged exposure it really does create problems."

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