What Are Symptoms Of NAS?

What are the symptoms of NAS? How one mom found hope

By Donald Creadore

Jeramay Martinez went through extensive training before she was approved to become a foster mom living in of Espanola, New Mexico. But no one warned her how to look for the symptoms of Neonatal Abstinence Syndrome, or NAS – a medical diagnosis assigned to the hundreds of thousands of U.S. kids exposed to opioids as a fetus developing in their mother’s womb.

Everything changed for Martinez from the day she brought home her foster son, who’d been born to a 25-year-old local woman struggling with addiction issues and incapable of raising children.

“The first two and a half months are really hard,” says Martinez, recalling her challenges of taking her foster son home after two stressful weeks in the hospital’s neonatal intensive care unit, or NICU. “Most people would have freaked out, because he shook, he cried a lot, and he needed comforting…It took a lot of comfort and love but now he’s doing OK.”
Before her first experience as a foster mom, Martinez had worried about many things: The hard work she knew would be needed to care for an infant and toddler, and the emotions that might come if and when the time came to hand that child back to her birth mom.

But in many ways, raising a boy born with NAS has proven to be much more challenging than Martinez could have imagined. The constant crying and shaking in those early weeks were followed by stomach problems. And now that her son, born in 2018, is a toddler, he struggles with his motor skills and requires physical, speech, and occupational therapy. And yet Martinez couldn’t imagine life without him.

She realized her initial dream — bringing the boy’s mom home to live with her and helping her get off opioids to be able to raise her own son — was overly optimistic and perhaps naïve. Within two weeks, the birth mother – who’d been legally prescribed Purdue Pharma’s OxyContin as a teen but then suffered through eight years of addiction – was gone. Martinez is now legal guardian of boy, now 19-months-old, and hopes to permanently adopt him.
NAS: A misunderstood American crisis

The story of Martinez and her son are just one of hundreds of thousands of families struggling with the Nation’s opioid public health crisis. You probably know that America has been rocked for more than two decades of opioid overuse and misuse through Big Pharma flooding the market with prescription painkillers, lacking discrimination and in seeming defiance of warnings of a growing addiction crisis.

The impact on America’s adults is both mindboggling and sweeping. Sadly, over 400,000 Americans have reportedly died from opioids during the period of 1999-2017 (from opioids obtained legally in addition to illegal street drugs). This figure is roughly equal to the number of U.S. soldiers killed in World War II, to provide some perspective to the enormity of the current opioid health crisis. Other social consequences and burdens of the Nation’s’ ongoing opioid health crisis is the alarming and unprecedented spike in the number of children who require foster care because of their parents’ addiction to opioids, whether they were prescribed or not. Inexplicably, largely overlooked by society is the impact of the opioid crisis upon children of mothers that had been prescribed opioids during child-bearing age or while pregnant from a doctor that may also been fully unaware of the medical risks to their fetuses.

Opioid Justice is a group of lawyers dedicated to working together in researching and addressing these complex issues, and it estimates that about 250,000 babies are born every year in the United States that, like the baby that went home with Ms. Martinez, will also likely need specialized medical monitoring and treatment. Of the estimated 3.8 million women who gave birth annually, roughly 1.3 million had been prescribed an opioid painkiller, according to one report. Putting that in perspective, that means that every 19 minutes a baby with symptoms of NAS or other problems due to opioid exposure is born somewhere in the United States.

What are the symptoms of NAS?

There is no way to diagnose NAS while the child is still in the womb. When the umbilical cord is cut, the baby’s body and brain receptors begin to experience altered levels of neurotransmitters such as dopamine, norepinephrine, and serotonin <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628571/> — the same type of withdrawals that adults experience from the sudden and abrupt cessation of drug use.

Following birth, the distressing symptoms of NAS (i.e. exposure to opioids while in utero), begin to emerge within hours or, sometimes, 2-3 days following birth; the first signs typically involve a combination of uncontrollable irritability, inconsolable crying, tremors, diarrhea, vomiting, sweating, fever and poor sleep and feeding patterns. Studies establish that babies diagnosed with NAS require longer, and more involved, stays in a hospital’s neonatal intensive care unit (NICU) before they can go home. The outcomes for this enormous population of newborns (diagnosed with NAS) is further handicapped by the fact that the federal government has yet to finalize its clinical definition for NAS.

Recommended initial treatments for newborns diagnosed with NAS range from soothing ‘skin-to-skin’ contact with the mother or, when unavailable, another caregiver, to pharmacologic weaning through the use of methadone or morphine; all in an effort to carefully ease the baby off drug dependency with the fewest complications and least suffering. Surprisingly, little is being done to medically monitor newborns diagnosed with NAS once they are sent home from the hospital’s NICU, notwithstanding the mounting medical studies demonstrating that injuries and disorders due to exposure to opioids while in utero can continue throughout childhood.

As opioid-exposed children mature, many will come to exhibit behavioral problems, cognitive delays, mental or motor deficits, as well be diagnosed with attention-deficit disorder (ADD). It is also noteworthy that – as the opioid crisis widens – doctors are also detecting other birth defects that can be attributed to NAS, such as club foot, spina bifida, heart defects, cleft palate, hydrocephalus, esophageal atresia, gastroschisis, anorectal atresia, and diaphragmatic hernia.

A lack of resources for NAS

In New Mexico, Martinez said she struggled at first with a lack of community-funded resources for the ever-rising number of kids diagnosed with NAS or another problem associated with opioid exposure in the womb. Instead, as an adoptive mom Ms. Martinez has needed to improvise and adapt to current gaping holes in the support net. On her own accord, Martinez was able to locate an expert in baby massage whose work, over time, helped her son cope with early stomach problems among other issues.

“He had light sensitivity and sound sensitivity but has overcome that,” Martinez said. In addition to physical therapy her son is also receiving occupational therapy. Martinez, together with a friend who is also a doula(a non-medical companion for major events such as birthing), are looking to see if they can establish a safe haven under New Mexico law where addicted mothers can safely drop off babies they cannot care for.

“We need to work together to come up with things to help these kids,” Martinez said. “It’s better that we address their problems than just hide.” In 2019, Martinez joined numerous other parents and caretakers who signed onto a nationwide legal action against the large pharmaceutical companies, aiming to make them pay for the long-term care of children exposed to opioids in the womb.

The legal fight for NAS babies

Since 2018, class-action lawsuits have been filed by the members of Opioid Justice on behalf of opioid-exposed children and their guardians, in upwards of 40 states. Our legal team has been working hard to get children born to prescription opioid-dependent-and-using mothers to be recognized as their own legal class within the national opioid litigation currently before U.S. District Court Judge Daniel A. Polster, in Cleveland, Ohio.

Our efforts are linked closely to the ongoing complex negotiations – involving big pharmaceutical companies and scores of states and local municipalities hoping to recover their purported costs for dealing with the opioid crisis – aimed at a comprehensive settlement. Importantly, the members of Opioid Justice are fighting every day to make sure that children with NAS or other opioid-related syndromes are represented in the ongoing bankruptcy action filed by the manufacturer at the center of the crisis, Purdue Pharma, the maker of OxyContin, one of the most widely-prescribed painkillers on the market. A tentative settlement of its liability in the range of $10-12 billion has been reported.

A prime motivation and objective of the members of Opioid Justice is avoiding the mistakes that flowed from the historic settlement in the late 1990s with Big Tobacco. There, the major cigarette makers agreed to pay out billions of dollars that largely went to a coalition of states and other localities – similar in many respects to today’s opioid settlement talks. But in the tobacco case, the lawmakers in states and localities reportedly steered this cash to pay off their bills, fill potholes and pave roads, or build ballfields and parks; almost none of the money went towards smoking-cessation programs, or the widespread health problems that are rightly blamed on cigarettes, as intended.

That’s why it’s profoundly important for the public to know there’s still time for new plaintiffs to join our OxyContin birth defects lawsuit, but that window of opportunity is also getting shorter. If your child was exposed to opioid painkillers during pregnancy, we hope you’ll join us in our legal battle for an agreement that will benefit families, like the Martinez family, not lawmakers. We are fighting for justice for children born with NAS as well as all children suffering from NAS, and we would invite you to be part of the solution.

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source https://opioidjusticeteam.com/what-are-symptoms-nas/