Neonatal Narcotic Addiction: 10 Year Observation

Abstract

During the 10-year period 1960 through 1969, 384 infants were born to 382 heroin addicted mothers. One hundred ninety (49.4%) of the infants were under 2,500 gm in weight. Seventy -seven (40%) of these were low weight for date infants. Two hundred fifty-nine (67.4%) of the total group of infants developed signs of withdrawal within the first 4 days of life. One hundred seventy-eight or 68.7% of these manifested signs severe enough to require treatment. Eighty-one infants had mild withdrawal signs which cleared without treatment. The 178 treated infants represented 46.3% of the entire group of heroin exposed infants. Our data indicated that there was a direct correlation between the length of maternal addiction and the occurrence of withdrawal signs in the infants; that with an increase of maternal intake of heroin, there was an increased incidence of neonatal withdrawal; and that the closer to delivery the last dose of heroin was taken, the higher and earlier was the occurrence of withdrawal signs in the neonate. Response to treatment with chlorpromazine was excellent. The incidence of congenital anomalies was no higher than in the general newbron population. Morphine and quinine could be demonstrated in the urine of the newborn infants within the first 24 hours of life. Fourteen infants (3.6%) died in the neonatal period; nine of these within the first 9 hours after birth. No evidence of Hyaline Membrane disease was found at autopsy in those that died in respiratory distress.

Infants born to narcotic-addicted mothers.

“…On the other hand, with one exception (Davis & Chappel, 1973), infants born to mothers who are maintained on methadone are reported to fare better in regard to birth weight than infants born to mothers who are addicted to heroin (Blatman, 1973;Kandall et al, 1975;Zelson, JaLee, & Casalino, 1973). Although no firm correlation between birth weight and maternal dosage has been established (Newman, 1973;Zelson et al, 1971), it is possible that the longer the mother has taken methadone, the higher the birth weight of the infant (Zelson et al, 1973). Infants of methadone-addicted mothers, however, suffer a greater postnatal weight loss than do infants of heroin-addicted mothers (Kandall et al, 1975;Ostrea, Chavez, & Strauss, 1975;Strauss, Andresko, Stryker, Wardell, & Dunkel, 1974), which may be related to the fact that infants who are addicted to methadone show a higher incidence of withdrawal and have more severe withdrawal symptoms than do heroin-addicted infants (Rajegowda et al, 1972;Zelson, 1973).…”

“…(p. 258) Although the majority of narcotic-addicted infants are born with normal Apgar scores, signs of withdrawal generally develop within from 24 to 72 hours after delivery (Desmond & Wilson, 1975;Ramer et al, 1973;Zelson, 1976). These complications necessitate an average hospital stay anywhere from 6 to 20 days Zelson et al, 1971). Cases with delayed onset of symptomatology, occurring from 2 to 4 weeks after birth, constitute about 10% of the total population and may be due to fetal accumulation and delayed excretion of the drugs (Kandall & Gartner, 1974).…”

“…The results of the Brazelton scale coincide with the disturbing symptoms cited with the greatest frequency by caretakers of narcoticaddicted infants. These symptoms include irritability, hyperactivity, and feeding and sleep disturbances (Cobrinik et al, 1959;Davis & Chappel, 1973;Davis & Shanks, 1975;Desmond & Wilson, 1975;Randall & Gartner, 1974;Lodge, 1976;Nichtern, 1973;Rajegowda et al, 1972;Ramer et al, 1973;Wilson et al, 1973;Zelson et al, 1971). Investigators have consistently described two behavior patterns in the early weeks of the narcotic-addicted neonate (Davis & Shanks, 1975;Desmond & Wilson, 1975;Wilson et al, 1973).…”

“…Lack of statistical analysis. Many studies provide a review and description of a particular population of drug-dependent women but fail to provide adequate analysis of the data (Blinick et al, 1973;Cobrinik et al, 1959;Desmond & Wilson, 1975;Fricker & Segal, 1978;Hill & Desmond, 1963;Kandall & Gartner, 1974;Reddy et al, 1971;Zelson, 1973;Zelson et al, 1971). An inherent danger in such efforts is that records may be incomplete and/or unreliable (Nichtern, 1973).…”

“…Low birth weight. It has been established that infants born to heroin-addicted mothers are, on the average, small for gestational age (SGA), with approximately 50% below 2,500 grams (Fricker & Segal, 1978;Harper, Sia, & Blenman, 1973;Kandall, Album, Dreyer, Comstock, & Lowinson, 1975;Ramer, Webb, Ramer, & Mondanaro, 1973;Reddy, Harper, & Stern, 1971;Stone, Salerno, Green, & Zelson, 1971;Zelson, 1973;Zelson, 1976;Zelson, Rubio, & Wasserman, 1971). There is some speculation as to the cause of this high incidence of low birth weight.…”