PENNSYLVANIA - Nicole Ehredt of East Liberty was in methadone treatment when she delivered three of her four children, struggling to break a drug habit that started when she was 12.
The youngest suffered tremors from addiction when he was born underweight two years ago at a Cambria County hospital. Ehredt, 30, took her son home and breastfed, providing the methadone and easing his symptoms. When he was 6 weeks old, she weaned him by switching to formula.
“[The tremors] went away after he [nursed],” Ehredt said. “He's still a small baby.”
The state doesn't mandate substance testing for newborns, track the number of babies born addicted or require hospitals to report women who are in drug rehabilitation when they deliver. Reporting is mandatory only when babies born to mothers not in rehab have withdrawal symptoms. At least 648 babies were born addicted or treated for addiction last year at Uniontown, Magee-Womens Hospital and West Penn and Forbes hospitals. Although hospitals aren't required to track them, officials agree the number has multiplied in a decade in tandem with a statewide surge in heroin and prescription drug abuse.
At Excela Health Westmoreland Hospital, which delivers about 1,800 babies a year, addicted infants typically fill two of the six beds in the special care nursery, nurse practitioner Kathy Eisensmith said.
“We have had times when every baby in that unit has been in drug withdrawal,” she said.
Nearly 30 percent of the babies delivered at Uniontown Hospital in one year were addicted, said nurse Lea Walls, director of Family Beginnings Birthing Center. Their mothers used opiate street drugs — heroin, morphine, oxycodone — or prescription pain medication while pregnant, she said.
Nationally, the number nearly tripled between 2000 and 2009, to 3.4 per 1,000 hospital births, according to the Journal of the American Medical Association. Sixty to 80 percent develop Neonatal Abstinence Syndrome, a withdrawal condition.
Because newborns in withdrawal need more intensive care and hospital stays of four weeks to several months, medical costs, too, more than tripled, data show. Hospital billings to private insurers or Medicaid rose from $190 million in 2000 to $720 million in 2009, when the average was $53,400 per baby. Medicaid paid for 77 percent of those deliveries, including Ehredt's son.
In Pennsylvania, the number of addicted births covered by Medicaid rose from 883 in 2010 to 1,122 in 2012, according to the Department of Public Welfare. In 2012, Medicaid paid $17.3 million — an average of $15,449 per birth — compared to $15.1 million in 2010. The actual hospital billings were higher, according to welfare department spokeswoman Kait Gillis.
The long-term effects of prenatal exposure to drugs aren't certain. Both drug and alcohol exposure raise the risk of infant death, developmental delay, poor school performance and learning disabilities, West Penn tells parents. Although fetal addiction has little impact on motor skills, the risk is higher for behavioral disorders such as aggression and attention deficit hyperactivity disorder, said Dr. Harolyn Belcher, family center director of research at Kennedy Krieger Institute in Baltimore, a children's research hospital.
Addicted newborns require close monitoring as they are weaned from drugs, often through morphine. While the ratio of nursery care for healthy babies is six per nurse, the highest ratio in the special care unit is three per nurse, Eisensmith said. Many pregnant women enroll in drug rehab programs, typically taking methadone or subutex. But those drugs, too, can cause fetal addiction.
“The majority of women we see here are already on methadone. We have a very large clinic for women on methadone or who want to convert,” said Dr. Barbara Cohlan, director of the neonatal follow-up clinic at Magee-Womens Hospital, where the number of addicted babies treated rose from 67 in 2005 to about 250 in 2012.
Some of the mothers are Westmoreland County jail inmates. In 2013, 32 inmates tested positive for pregnancy; 13 were sent to Magee to start drug withdrawal treatment, said Warden John Walton.
“Most of it is heroin (use),” he said. Westmoreland County Common Pleas Judge Rita Hathaway has jailed pregnant defendants who continue to use drugs, even while they are on parole or probation. “At least I know I can keep them clean until delivery if they are incarcerated,” she said.
Allegheny County Jail records, available only from August through December of 2013, show 22 inmates tested positive for pregnancy. Women in withdrawal are sent to Magee for methadone treatment; those already in rehab receive follow-up care at an Oakland treatment center.
Officials estimate a 50-50 mix of heroin and prescription drug use. Attorney Tom Plaitano operates methadone clinics in Greensburg and Blairsville, Indiana County.
“Five years ago, if we had three to five patients who were pregnant, that was a lot. Today, 15 to 30 is the norm,” he said. “They are your neighbors, family members, coworkers and college students.”
BABIES CAN THRIVE
Dr. Neil Capretto, medical director at Gateway Rehabilitation Center in Beaver County, said taking methadone under a doctor's supervision is better for pregnant women and their babies than turning to prostitution or crime to buy street drugs. They also can learn about social service resources.
“For some of these women, pregnancy is a blessing in disguise,” Capretto said. Walls has crafted a $10,000 grant proposal for a pre-admission program to counsel and support pregnant women enrolled in drug rehab programs.
“We (hospital staff) are only a ‘blink' in their life, but anything we can do for best outcomes is our goal,” she said. Ehredt, a single mother, moved to Allegheny County to enter a life skills residential program through Sojourner House and said she has been drug-free for a year.
While she is critical of methadone, “it helped me deliver healthy babies,” she said. “Fortunately, my kids didn't go into horrible withdrawal or have to be in the (neonatal intensive care unit). Doctors told Ehredt her pregnancy prevented a cold turkey withdrawal from drugs.
“Any guilt I feel is more in the fact that I abused it (methadone). I didn't get clean. I just wasn't ready,” she said. West Penn pediatrician and neonatologist Dr. Robert Cicco said a baby born drug-addicted can thrive in an environment with caring parents.
“A woman who is untreated (not in rehab) with a dependency on opiates has a difficult time fulfilling that [caring] role,” Cicco said. “The message is to never become dependent, period.”
2/9/14 - By Mary Pickets, The Tribune Review @ Triblive.com
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