SMALLEST VICTIMS Narcotic-dependent newborns growing along with drug epidemic

Posted: March 31, 2017

Sierra Weitzel and baby Mia

Sierra Weitzel shot heroin every day until she was homeless, broke and four months pregnant. Her body writhed from the early stages of withdrawal as she waited for emergency room doctors to tell her if her baby was dead.

“I didn’t know if I was still pregnant,” the 22-year-old Tinicum woman said. “I was so mixed up in my emotions. I was crying and throwing up. I didn't want to know how (the baby) was. I was too afraid."

When doctors assured her the baby was alive, Weitzel said she dropped to her knees, clasped her hands and thanked God. The first-time mom then got treatment, including methadone, a synthetic opioid prescribed to wean her off heroin.

She swore her baby wouldn't grow up like she did — with a mother who was addicted to painkillers and alcohol. While drugs didn't kill her mom, Weitzel believes they shortened her life. 

When Weitzel's daughter, Mia, arrived in January 2016, she was five days overdue, weighed a healthy 7 pounds 15 ounces and was dependent on the methadone used to treat her mother during pregnancy.

The first signs of neonatal abstinence syndrome appeared shortly after Mia was born. Withdrawal syndrome occurs when newborns are exposed to narcotics in the womb. Symptoms can include tremors, vomiting, diarrhea, irritability, sleep problems, fluctuating body temperature, seizures and gastrointestinal upset.

The number of newborns who've been exposed to drugs in the womb is growing, medical providers say, as the ripples of this narcotics epidemic reach the youngest, most vulnerable — and often overlooked — population.

How many babies are affected? No one knows, since there are no consistent, comprehensive measures to detect, track and protect them.

• Different hospitals have different screening procedures and reporting methods.
• Not all babies or mothers are tested for drug exposure.
• Not all newborns who are exposed in the womb develop withdrawal symptoms. 
• Not all babies with positive drug tests may be brought to the attention of child protective services.
• A Pennsylvania law that requires checks on a child's welfare doesn't address what doctors say is the largest source of drug-exposed babies — legally prescribed opioids.

Child welfare advocates argue that government agencies and policymakers can't make informed decisions about laws and rules designed to address fetal drug exposure because they don't have a baseline to measure it.

"It isn't just knowing the overall number (of exposed newborns), but knowing the number in a timely way, as well as the type of exposure," said Cathleen Palm, founder and executive director of the Center for Children's Justice in Berks County. "Right now in Pennsylvania, there is no specific spotlight or coordinated strategy about the opioid epidemic and its impact on kids.”

Babies treated for withdrawal syndrome typically make a full recovery physically. Weitzel didn't know what exactly would happen when her baby was born, but she said she put her faith in the doctors at Grandview Hospital when Mia showed signs of withdrawal.

She recalled the heartbreaking time, just days after Mia's birth, when the muscles in her tiny body would stiffen when she was held. She couldn’t latch onto her mother’s breast to feed. She was tightly swaddled to regulate her body temperature and control tremors.

For nine days, doctors watched Mia's symptoms. So did Weitzel, who slept in the hospital. At night, Weitzel cradled Mia, refusing to let her go until the nurses nudged her to put the baby down and try to get some sleep.

"I would get depressed; I knew she didn't deserve this," said Weitzel, who has been sober for nearly 20 months. "It was hard watching her go through pain like that and not being able to do a thing.”

In Weitzel's case, the doctors knew about her addiction and were prepared to treat Mia. That doesn't always happen,  doctors say. Too often, doctors say mothers hide their addiction, so hospitals and caseworkers can't prepare in advance to treat babies born into addiction or even track those whose symptoms are mild or who have no symptoms.

From what doctors and hospitals do know, the number of babies diagnosed with withdrawal syndrome has steadily risen during the past 15 years, along with the nation’s growing abuse of opiates such as heroin and opiods such as oxycodone. The number of affected babies in the country who were admitted to neonatal intensive care units jumped from seven per 1,000 admissions to 27 per 1,000 between 2004 and 2013, according to a study in the New England Journal of Medicine in 2015.

Hospital costs of treating drug-dependent newborns and their mothers have gone from $732 million in 2009 to $1.5 billion in 2012. State Medicaid has paid 81 percent, according to a study in the Journal of Perinatology, which focuses on maternal, fetal and newborn care.

“Individuals who don’t pay attention to this are burying their heads in the sand. It’s a major health issue,” said Dr. Joel Sorosky, chairman of the OB-GYN Department at Abington Hospital-Jefferson Health. “Our neonatal unit used to be a spot for premature babies, but now it’s booming for reasons that could be preventable with education.”

Since 2003, federal law has required states to advise child welfare authorities of affected newborns, but Pennsylvania has a blanket exception for babies exposed to narcotics through doctor-ordered prescription drugs, including methadone. Child welfare advocates say the exception places medically fragile babies at risk for abuse, neglect and even death in homes with unstable caregivers who are unprepared for the demands of a newborn.

Among Medicaid births in Pennsylvania, at least 61 of the more than 7,500 babies born addicted to drugs between 2010 and 2014 died before their first birthdays, according to state data obtained by Palm, of the Berks County-based children's justice center. Some deaths were linked to parental substance abuse, Palm said. There's no reliable data available for births to women with private insurance, Palm said. 

Heroin and synthetic opioids are among the most addictive drugs because they disrupt and overtake the brain and central nervous system functions. With chronic use, the brain's endorphin-secreting cells rely on the narcotics to function and the body requires higher doses to prevent withdrawal symptoms and allow users to feel normal, according to drug treatment specialists.

A 2016 University of Pennsylvania study found evidence that such dependence interferes with the natural care-giving instincts of humans, essentially reducing their ability to care for others. But when researchers treated chronic users with naltrexone, a drug that blocks the effects of narcotics, their brains produced the type of caregiver response found in healthy brains.

“Families that suffer from addiction don’t love their children any less, but they can have a diminished capacity to care for them,” said Laurie O’Connor, director of the Montgomery County Office of Children and Youth. "You don’t see that kind of thing with other kinds of drugs."

Sierra and baby Mia

The impact of parental substance abuse on children is something the Pennsylvania Legislature is addressing. A bill to create a task force charged with developing strategies for improving the safety and well-being of these children was unanimously voted out of the House Children and Youth Committee on March 22 and is expected to be up for a  full House vote perhaps as soon as April. 

“These children are the innocent victims,” said Rep. Katharine Watson, R-144, of Warrington, who proposed House Bill 235 and chairs the House Children and Youth Committee. “We, as a commonwealth, have a responsibility to protect them as children and what we know is, if (they're) not taken care of and protected, if you look at a balanced ledger line in the budget, it will cost more later.”

Protection was the priority when the Bucks County Children and Youth social services agency became involved with Mia and Weitzel, the mom acknowledged.

But rather than separate mother and infant, the caseworker who showed up when Mia was 2 days old provided support for her, Weitzel said. When Mia was discharged after nine days of treatment for methadone withdrawal, the caseworker developed a care plan that included weekly home visits from the caseworker to teach parenting skills.

Still, Weitzel said, "there was always this fear in the back of my mind that I could lose her — even though I was doing everything right (by getting treatment)."

The agency was ready to close its case with Weitzel after three months, satisfied that Mia, who's now nearly 15 months old, was in a safe home. But when her caseworker asked if she wanted three more months of help and support, Weitzel quickly agreed.  

Today Weitzel is grateful — for the doctors who didn’t judge her, for the caseworkers who taught her to care for Mia, and for her family who took her in and never gave up. Weitzel hopes to one day become a certified recovery specialist so she can help pregnant women facing addiction realize they have a chance to save themselves and their babies.

"Just because you're pregnant doesn't mean the addiction switch turns off; I know that, and what they need is for the community to understand that, like any other disease, they (people with addiction) need treatment," Weitzel said. “They also need to know they are not alone, that people care. My baby is doing awesome today, but I couldn’t have done it alone.”