Dr. Russell Kirby tracks neonatal abstinence syndrome in the opioid epidemic

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January is National Birth Defects Prevention Month

An increasing number of infants are being born with a syndrome resulting from exposure to opioids while in the womb, according to USF College of Public Health’s Dr. Russell Kirby.

However, he says tracking it has become a new challenge.

Infants born to mothers who used opioids or pain relieving drugs during pregnancy are at risk of developing neonatal abstinence syndrome (NAS) or neonatal withdrawal syndrome, according to Kirby, a distinguished university health professor of community and family health.

“NAS is a major public health concern relating to pregnancy and infant health,” he said. “The incidence of NAS has skyrocketed since the 1990s.”

“Infants typically are irritable or jittery, cry incessantly, and are difficult to comfort,” Kirby said. “Not all infants born to mothers who used prescription or illicit drugs during the pregnancy will have NAS, nor were all infants with NAS exposed to opioids, although the large majority were.”

According to the March of Dimes, infants with NAS are more likely to be born with low birth weights and have difficulty breathing and feeding, as well as experience seizures.

Kirby said NAS prevalence continues to rise in Florida and nationally.

Infants with NAS typically have longer hospital stays than non-exposed healthy newborns, Kirby said.

“NAS infants often need pharmacologic treatment with an opioid, and sometimes require a second drug to manage symptoms,” said Dr. Maya Balakrishnan, associate professor of pediatrics at USF. “However, most providers advocate for non-pharmacologic management of symptoms, such as decreased stimulation, skin-to-skin care, decreased lighting, and addressing feeding needs.”

In 2015 the U.S. medical coding system—also known as the International Classification of Diseases (ICD)—changed codes and definitions for diseases and conditions, making tracking of NAS cases more difficult, according to Kirby.

Russell Kirby, PhD, MS

“The problem is that we don’t know about the comparability of the codes,” Kirby told the Orlando Sentinel. “That’s probably something we need to evaluate.”

Kirby and his team at the USF Birth Defects Surveillance Program are currently assisting the Florida Department of Health (FDOH) in tracking NAS through a review of all Florida hospital records involving infants with drug exposure or withdrawal.

The FDOH now requires mandatory reporting of any NAS-related cases.

Kirby said reviewing the records statewide will help to determine how various ICD codes are used and which are most indicative of NAS, which Kirby said does not yet have a specific or unique ICD code.

“The sociodemographic profile for infants with NAS is different from stereotypic notions—these infants are as likely to be born to non-Hispanic white mothers, and to families with higher socio-economic status, as they are to minorities and the disadvantaged,” he said.

The long-term consequences of NAS in child development remain unknown, Kirby said, however, infants with NAS are at a higher risk for sudden unexpected infant death, child abuse, neglect and malnutrition.

While not all women who use opioids are addicted, with some using them for prescribed pain relief per their health care providers, Kirby said there is an opportunity to prevent NAS among infants.

“For a start, we could change the prescribing habits of physicians who provide initial prescriptions to patients requiring pain management, to provide medication for only two or three days and require the patient to return to the clinic for re-evaluation prior to receiving addition doses,” he said. “We could also change our strategies for methadone treatment toward protocols with the goal of completely weaning patients from the use of these drugs; at present our policies enrich the owners of clinics who keep their patients perpetually in their treatment programs.”

Related media:
Amidst opioid epidemic, new medical codes may have muddled data

Story by Anna Mayor, USF College of Public Health

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