BANGOR- Babies born to opiate-addicted mothers are almost always addicted, too. In eastern Maine, where young women of childbearing age make up the fastest-growing segment of the opiate-abusing population, the number of babies who begin their lives in the physical and emotional distress of opiate withdrawal is increasing as well.

In 2003, the staff of the neonatal intensive care unit, or NICU, at Eastern Maine Medical Center in Bangor cared for 35 babies born with neonatal abstinence syndrome, or NAS. In 2004 and 2005, the number was about 50 each year. Through mid-November of this year, about 70 newborns have been treated for opiate addiction – a 100 percent increase in three years.

These numbers are staggering to neonatologist Mark Brown, who practiced for more than 25 years in Colorado before moving to Bangor last spring to take charge of the NICU at EMMC.

“It was a shock to me to see the depth and breadth of the opiate addiction problem here, especially as it affects babies,” he said during a recent interview. Before moving to Bangor – which has among the highest opiate addiction rates in the nation – Brown could count on one hand the cases of NAS he had encountered. The art and science of treating babies born addicted to methadone is still young, he said, and EMMC’s high census puts it on the leading edge of an emerging specialty field.

It takes several weeks for a drug-addicted newborn to stabilize, and it’s an exhausting time for all concerned. Infants diagnosed with NAS are nervous, jumpy and jittery. They sleep fitfully, cry frequently and inconsolably, and endure muscle spasms, tremors, sweats, hiccups, nasal stuffiness and sneezing fits. Their ramped-up metabolism causes them to burn extra calories, but despite an excessive, often frantic, need to suck, they are typically poor feeders and may regurgitate much of what they eat. They often run a fever and have elevated heart and breathing rates.

Brown said NAS babies are treated with low doses of drugs that answer their bodies’ inborn craving for narcotics and calm their overwrought nervous systems. These medications may include tincture of opium, methadone, phenobarbital and others. The doses are decreased over time in a weaning process that can take several weeks or longer.

During this time, babies must be intensively monitored to ensure they’re not overmedicated, which could lead to cardiac or respiratory arrest, brain damage and death. Each tiny bedside in the NICU is crowded with equipment – heart monitors, oxygen sensors, feeding tubes, vital sign recorders, intravenous pumps and more. Once they’re relatively stable, babies may be transferred to the less-hectic neonatal continuing care nursery and then to the general pediatric unit.

According to Patient Care Administrator Frances Loring, the hospital’s cost of caring for the average healthy newborn – which many of these NAS babies would be if they weren’t born with an addiction – is about $568 for a two-day stay in the nursery. The cost of a typical four-week stay for an addicted baby is $34,594. Because 99 percent of these babies are covered by the state’s MaineCare program, Loring said, the financial burden falls squarely on the shoulders of Maine taxpayers.

More moms seek treatment

If there’s a silver lining to any of this, it may lie in the fact that an increasing number of the NAS babies at EMMC are being born to women enrolled in a methadone maintenance program. This represents a significant shift in drug users’ attitude, according to NICU department head Tina Gist.

“The word on the street used to be ‘they’ll take your baby,'” she said last week. “But now they know it’s a pretty neutral environment over here. The new assumption is that they’ll be able to go home with their babies.”

Before any child can go home, however, Gist said, it takes a lot of teamwork – not only the high-tech skills needed to make sense of the reams of medical data generated about every NAS baby, and the more intuitive art of assessing their emotional states – but also the critically important business of teaching young parents to care for their needy infants.

“A lot of these young mothers have no family support at all,” Gist said. “And many of them have a lot of mental health baggage in addition to their drug addiction.” Nurses, social workers and others have their work cut out for them.

Family support coordinator Mark Moran, a social worker formerly employed with the Maine Department of Health and Human Services, said state law requires him to report the birth of babies with drug addictions to DHHS Child Protective Services. That report guarantees that either the state or a local agency will visit the baby’s home to ensure its safety and well-being – but it doesn’t mean parents should fear losing their child, he said. The goal is to keep children together with their birth mothers whenever possible, especially if extended family members are supportive.

Brent Scobie, director of substance abuse services at The Acadia Hospital in Bangor, said there are 20 to 25 pregnant women now in the methadone maintenance program. The number holds pretty steady between 20 and 30 at any given time. These young women, he said, are among the most compliant of the program’s clients.

“For better or worse,” Scobie said, “pregnancy is often the impetus they need to get into treatment and stay there.” About 90 percent continue in methadone maintenance after their babies are born, he said. Many of the roughly 700 people in the methadone program bring their children with them, either daily or, for some with take-home privileges, less often.

Scobie said 160 to 190 babies and toddlers accompany their parents when the parents visit Acadia for their methadone treatment. In most cases, the mothers were in the program during their pregnancies.

“The sooner a mom gets into methadone treatment, the better for her baby,” said psychiatrist Paul Tisher, chief medical officer at Acadia. Mothers-to-be who maintain a steady level of methadone in their bloodstreams – instead of “pulse-dosing” with periodic hits of heroin, OxyContin or other opiates – increase their infants’ chances for a relatively uncomplicated recovery.

While these babies may show some slowed development in their early months, “after a year, they’re pretty well caught up,” Tisher said. But there are few data on the long-term effects of being born to a mother in methadone treatment, he said, although environmental factors such as ongoing medical care, parenting techniques, attention to educational needs, family support and general lifestyle probably have more influence than those first early days in the NICU.

Tisher is optimistic about a new “well baby” clinic now in the early planning stages, a project between Acadia Hospital and the family practice program at EMMC. The clinic will be located within the methadone program at Acadia, convenient for parents who already bring their youngsters when they come for their own daily dosing.

Tisher said the well baby clinic also will offer an opportunity to assess the children and interact with their parents over time, providing valuable data for understanding the dynamics of opiate addiction in individuals and families.

“There are always kids running up and down the hall. You wouldn’t know they’re any different than any other kid. … We’re looking for any opportunity to help these people be better parents, to not be afraid to seek medical attention for their children,” Tisher said. “Many of the moms at Acadia feel health care providers don’t understand opiate addiction … but they’re comfortable with us.”