Pubdate: Sun, 14 Jun 2015
Source: Dayton Daily News (OH)
Copyright: 2015 Dayton Daily News
Author: Chris Stewart


1700 Drug-Exposed Infants Born in Ohio in 2013 As Heroin Scourge 
Drives Ninefold Increase Since '04

The youngest heroin addicts aren't even born yet. Still in the womb, 
they are exposed to opiates by expectant mothers with drug habits 
sometimes so insatiable and all-consuming the pregnancy goes 
undetected for months.

And, fueled by opioid use by pregnant women, more of these young 
addicts are born every day. Nearly 1,700 drugexposed infants were 
born in Ohio in 2013, a nearly ninefold increase from 2004, according 
to the Ohio Department of Health.

The babies often require complex - and expensive - medical care to 
wean them off drugs, requiring lengthy hospital stays that can run 
into the tens of thousands of dollars.

Some of the mothers use right up until the day of the birth. Leigh 
Ann Marburger of Kettering was two and a half years into a heroin 
habit, using up to 10 caps a day, when she learned she was five 
months pregnant.

When her son Jameson was born about two months later, she was still 
shooting a cap a day.

"I didn't plan it but that's what happens. People are using," she 
said. "They're not taking birth control because their only thought is 
heroin, heroin, heroin, heroin. I got to get my fix. I got to get my 
fix. And they'll do anything to do it besides do what they need to do."

Marburger said she tried to get help after a positive pregnancy test 
but was told there wouldn't be space open in a treatment program for 
weeks - a common complaint among heroin addicts. She was able to wean 
her habit down some with help from family members, but she wasn't 
completely clean. Then her water broke. "So I had to go to the 
hospital with heroin still in his system, heroin still in my system," 
she said. "Once I saw that baby - three pounds, nine ounces - it was 
devastating. All I could do is sit there and watch him cry in the incubator."

Her son, who turns 2 today, spent the first weeks of his life in the 
hospital and then in court-ordered foster care. Marburger's mother 
now has legal custody of Jameson and Layna, who was born 14 months 
after her brother and suffered even worse withdrawal symptoms at birth.

Layna's addiction was methadone. For 34 weeks prior to her birth, she 
shared the same medicine her mother drank daily at Project CURE to 
keep her off heroin.

"She went through methadone withdrawal. Screaming, crying, tremors, 
uncomfortableness, restlessness - the same signs as heroin," Marburger said.

Layna spent 54 days in the hospital, her mom said. Today she's 
brighteyed and agile on all fours, crawling around her grandmother's 
apartment, where she and her brother live.

"Neither one of them has any problems, thank God," Marburger said. 
"Knock on wood, I hope they don't later on in life."

Millions spent to treat infants

Ohio has never before encountered the staggering number of infants 
born with opiates in their systems, and the mounting costs are 
threatening to overwhelm social service agencies and government at all levels.

It's become such a problem that the state is spending millions to 
discover ways to better treat drug-exposed infants, so hospital stays 
can be reduced.

The average infant born in Ohio in 2013 spent about 3.8 days in a 
hospital before being discharged at a cost of $13,541, according to 
the Ohio Department of Health. A drug-exposed baby, however, was 
hospitalized on average about 15 days in 2013, the most recent year 
complete state records are available.

The $57,897 cost in 2013 was nearly double that of 2004. Medicaid, 
the taxpayer-funded health system for the poor and disabled, covered 
87 percent of the babies diagnosed with Neonatal Abstinence Syndrome, 
or NAS, that year,

Amount spent in Ohio caring for drug-exposed babies in 2013.

Percentage of women 15-44 using illicit drugs during pregnancy, 
2012-2013. running the tab to taxpayers to $28 million. The total 
cost for drug-addicted infants in 2013 was more than $97 million.

While Ohio's 2014 numbers haven't been finalized, local totals show 
another increase in cases. Hospitals in 10 counties represented by 
the Greater Dayton Area Hospital Association reported 216 
drug-addicted newborns last year - up from 195 in 2013 and a 38 
percent increase from 2011.

Babies become addicted to heroin in much the same way adults do.

"Once in the baby's bloodstream, (opioids) have access to the brain," 
said Dr. Marc Belcastro, a neonatologist and medical director of 
Miami Valley Hospital's neonatal intensive care unit. "They then 
stimulate all the receptors that those drugs attach to and start to 
produce the chemical changes that create a dependency situation in 
the baby's physiology."

Withdrawal, when it occurs, typically hits within 72 hours after birth.

"The lack of the drug then causes a very marked set of signs and 
symptoms that we have to deal with," Belcastro said.

'The cry that goes right through you'

Lisa Jasin knows too well the sounds of a drug-addicted baby.

"They do a lot of crying," said Jasin, a neonatal nurse practitioner 
at Dayton Children's Hospital, where 18 babies were treated for drug 
exposure last year.

"The cry that goes right through you - you can't console the baby. 
They are kids that need a lot of attention."

Excessive or continuous high-pitched crying is the first category 
listed on the Finnegan Scoring System, used widely by the country's 
neonatal intensive care units to guide the treatment of newborns 
whose mothers test positive for drugs.

Beginning two hours after birth, a baby is evaluated every three to 
four hours after a feeding using a 22-point checklist of symptoms to 
gauge neurological, gastrointestinal and autonomic health. Additional 
signs that an infant is suffering from withdrawal include tremors, 
frequent yawning, vomiting, diarrhea, poor feeding, dehydration, 
nasal stuffiness and mottling.

If a Finnegan score is low enough, an infant may get through 
withdrawal without medication, but huge hospital resources still go 
into frequent smaller feedings along with holding, swaddling and 
rocking the babies for eight to 10 hours a day, Jasin said.

"Holding a baby for that period of time is much better than giving 
that baby morphine or methadone after their exposure," Jasin said.

Most drug-exposed babies - upwards of 80 percent - require medication, however.

"We don't really believe that opiates for babies are a good thing, 
but withdrawal in babies is definitely not a good thing, so it's the 
lesser of two evils," Jasin said.

Treating opiate withdrawal in a newborn with morphine or methadone is 
a balancing act, Belcastro said.

"It's challenging because you want to make them comfortable because 
they are in a significant amount of discomfort from the symptoms," he 
said. "But you don't want to overtreat and make them so sedate that 
you're creating a new problem by aggravating the dependency they already have."

More than a quarter of all NAS babies exhibit low birth weight, 
according to statistics kept by the Ohio Hospital Association. The 
other two most common health problems cited were feeding difficulties 
and respiratory symptoms.

Seizures also occur, though only in about 2 percent of the cases. 
Babies born with drugs in their systems are at 10 times greater risk 
for seizures compared to other newborns, according to ODH.

"I'm very thankful I have not seen a baby seize from withdrawal," Jasin said.

Ohio's efforts to reduce hospital stays using best practices have 
shown results.

A May progress report for a study involving hospitals around the 
state found the average length of treatment for drug exposure went 
down by a day and overall hospital stays by one to two days, said 
Rebecca Dupras, a nurse specialist at Soin Medical Center in 
Beavercreek who also sits on the committee that reports birth data to 
the state project.

'Where did my mommy go?'

It's not always clear if a mother's drug use caused her child's 
medical condition.

Seven-year-old Delaney Godek can belt out "Edelweiss" from "The Sound 
of Music" in near perfect pitch but can't ride her bike without 
straps holding her feet to the pedals.

Though vibrant and articulate, Delaney runs with difficulty and is 
prone to falling down, said Becky Short of Beavercreek Twp., her grandmother.

Short is raising Delaney, who is diagnosed with mild cerebral palsy.

"She even asks me, 'Grandma, am I always going to walk this way? Am I 
always going to fall down?' I tell her ... it should get better as 
you get older,'" Short said.

It's not clear if Delaney's cerebral palsy was caused by her mother's drug use.

But this much is clear: her mother's drug use deprived Delaney of a mother.

"About a week and a half ago she said, 'Grandma, where did my mommy 
go?'" Short said. "And I said, 'Delaney, I just hope she went to heaven.'"

Rachel Van Winkle, 36, Delaney's mother, overdosed on heroin and died 
last June.

Short believes her daughter's drug use during her pregnancy, which 
included alcohol, marijuana, cocaine and the opioid Vicodin, is why 
Delaney was born seven weeks early. Delaney weighed 4 pounds, 7 
ounces, was in the hospital for three weeks on oxygen, and came home on oxygen.

Doctors did an MRI when Delaney was 2 and diagnosed her cerebral 
palsy, Short said.

"She has trouble paying attention and staying focused. She falls down 
all the time because she doesn't have good balance. She walks 
obviously different from other children," Short said.

Delaney also has experienced grand mal seizures that have required 

Short said her daughter felt guilty about Delaney's situation.

"Throughout the years I'd say to Rachel - because I'd see commercials 
that would say, 'If your child has cerebral palsy, call these lawyers 
and we'll help you sue.' I'd say, 'Rachel, why don't you?' Short 
said. "And she'd say, 'No, mom, no.' She was real adamant about it. 
That was why she couldn't pursue it because she knew it was her own doing."

Educating moms

As a staff nurse specialist in the Obstetrics Department at Soin 
Medical Center, Rebecca Dupras sees two or three drug-exposed babies a month.

Their mothers shouldn't be ostracized, she says.

"If you sit down and talk with them, they all have a reason why and 
how they got addicted and it's just so hard for them to get off of 
it," she said. "Having a baby just adds one more thing that they are 
worried about and stressed about."

Dupras in March began teaching a class to addicted and expectant 
mothers at the Women's Recovery Center in Xenia.

She hopes to hold similar classes in the Greene County Jail.

Dupras goes step-by-step through what the women and their newborns 
will experience.

She tells them about the Finnegan scale, the potential effects the 
drugs may have on their babies, the weaning process for opiates, and 
the realities of Ohio law, which requires health providers to turn 
over the results of drug screens to children services agencies.

"I have a passion for these moms and babies. They're human, too," 
Dupras said. "Sometimes when I hear people say we need to just throw 
them in jail, there's more to them than that. They need the whole 
gamut: the counseling, the rehab. Just throwing a mom in jail because 
she's doing heroin isn't going to solve the problem."

Unknown impact

Because the heroin surge is a recent phenomenon, data on long-term 
effects from opioid exposure is limited. What little is known, 
however, suggests maternal opiate use may affect a child's mental, 
motor and behavioral development - at least initially.

Other risks often associated with heroin use include a lack of 
prenatal care, poor nutrition and other negative socio-environmental 
factors, health care providers say.

The drugs themselves, the environment around the drugs and the lack 
of prenatal care that often accompanies the use of drugs can all be 
toxic to a baby.

"Babies that are born prematurely - depending on how premature - are 
at risk for cerebral palsy, they are at risk for lung disease, they 
are at risk for growth problems, they're at risk to need oxygen for 
their lifetimes, they are at risk of asthma," Jasin said. "All of 
those things that go along with prematurity."

Drug-exposed babies don't exhibit a high mortality rate in the 
hospital, but the same children are more typically exposed to other 
environmental factors that increase infant mortality later, Belcastro said.

"Nutrition, socio-economic conditions, access to medical care, 
followup, and exposure to other high-risk situations like potentially 
smoking in the home or other drug use in the home can lead to 
conditions like SIDS and other respiratory conditions," he said.

'Just walk away'

Leigh Ann Marburger said she was introduced to heroin by Jameson and 
Layna's father.

Soon the two were scrambling to feed a $100-a-day habit, she said.

"It was to the point where I was selling my jewelry, selling my 
clothes, I was selling everything I could: my laptops, my iPods. 
Anything I could sell I did besides myself."

At times she resorted to stealing meat from grocery stores and 
reselling it for drug money.

Those days are done, she said.

Marburger reached a milestone in her recovery two weeks ago when she 
took her last dose of methadone. She has a date in court next month, 
hoping to regain custody of her children.

Marburger said heroin is readily available on nearly every street 
corner - from Germantown where she went to high school to Miamisburg 
where she lived for a time and to Kettering where she lives now.

When Layna was in Miami Valley Hospital recovering from her methadone 
exposure, Marburger was approached by someone peddling heroin as she 
took a walk near the hospital.

"My baby was in the hospital on methadone," she said. "It's everywhere."

She has advice for those curious to try the drug. "If anyone would 
offer you heroin, just walk away," she said. "Because once you do it, 
you do it again. It won't stop."
- ---
MAP posted-by: Jay Bergstrom