Massachusetts hospitals are seeing evidence that the opioid epidemic is affecting the next generation, with an increasing number of babies being born exposed to drugs.
The most recent state hospital data suggest that the rate of drug-dependent newborns has skyrocketed to about 16 in every 1,000 births — about three times the national average.
At Massachusetts General Hospital, doctors started following drug-exposed babies about three years ago. Dr. Leslie Kerzner, director of the Newborn Developmental Follow-Up Clinic at MGH, tracks the babies until age 2. She says the vast majority of infants exposed to drugs in utero will experience withdrawal symptoms similar to those of an adult going through withdrawal. (Click here for a video from MGH of an infant displaying symptoms of withdrawal.)
"A baby going through withdrawal is very disorganized," Kerzner explained. "They go from state to state, from alert awake to crying, you know, it's like zero to 60 in just a couple of seconds. They have increased muscle tone, a high-pitched cry. They're not easy to soothe. They may be throwing up, have diarrhea, mottled skin. They are not healthy looking."
Most of the moms that gave birth to exposed babies at MGH in the past year were white, their median age was about 30. More than 30 percent of the moms were prescribed opioids for chronic pain. Close to 90 percent of the pregnancies were not planned.
One of those babies was 1-year-old James. Shortly after birth he was diagnosed with what's called neonatal abstinence syndrome and given small doses of morphine and another drug to get him through the withdrawal.
"James did go through neonatal abstinence syndrome, requiring medical therapy with both morphine and phenobarbital — which is not unusual when a baby might have been exposed to other things," Kerzner said. "Many of the moms are poly-substance users."
Doctors knew that James had been exposed to methadone. Kristen Fontaine and her husband got involved when they were contacted by a social worker caring for the infant. They were looking to adopt and came to see James at MGH's special care nursery.
"He was 8 pounds, this tiny little thing," Fontaine recalled. "We were here 18 hours a day. My husband and I sat with him 18 hours a day and the nurses said that's what really got him through the whole process."
Doctors believe that bonding with a caregiver and being held and soothed helps these babies developmentally. Many try to keep the babies with their birth mothers, at least initially. Hospitals are required to file a complaint with the state when a baby is born exposed to drugs, even if a mother is prescribed them legally. The Department of Children and Families then decides where a child goes from there. From March 2014 to February 2016, DCF responded to 4,788 cases of children born exposed to drugs. More than 700 of those babies were placed in state custody.
James' case is unusual. He left the hospital with his adoptive parents when he was five and a half weeks old — which is considered a short amount of time. It's something Fontaine still has a hard time talking about.
"It just makes me happy that he is the way he is now," she said. "He's so full of life and he's so happy. It's hard to think about the kids that are there now. I just want to take them home too."
James does appear to be thriving. During a recent visit to Dr. Kerzner's clinic, Fontaine said she was grateful for the support she has — not just from this clinic, but from her own doctor and regular visits from state early intervention specialists. She told Dr. Kerzner about various programs she takes James to every week — baby swim, baby yoga, play groups. She's confident that he's going to be OK.
"He's going to be just be a normal happy kid," Fontaine said. "He's going to play baseball according to his dad. He's going to be a pitcher and he's going to be a lefty."
In fact, like most moms, Fontaine says her child is exceptional.
"We have a big huge, in our bedroom, 20 by 20 print of him wearing his 'Superman was adopted too,' " she said. "He's our little Superman, our little superhero."
There's not a lot of data on the long-term effects for babies born exposed to opioids. Dr. Kerzner says most of the withdrawal symptoms wear off in a few months. Some studies suggest there are lifelong effects for exposed babies, other studies suggest there are not.
Dr. Kerzner hopes to start answering some of those questions by gathering data from her clinic and expanding it to babies born at other hospitals. And the state plans to spend more than $3 million this year on improving care for drug-exposed babies and their mothers.
This article was originally published on March 25, 2016.