With drug use rampant in Maine, it's no surprise that in Maine, more babies are being exposed to narcotics during pregnancy. The state Department of Health and Human Services reports that the number of infants experiencing withdrawal symptoms has increased 16 fold, from 13 births in 2000 to 215 in 2008. Pediatrician Brenda Medlin takes care of the sickest of these infants at Maine Medical Center in Portland.

Medlin: One of the earliest and probably most significant manifestations of infants who are affected is jitteriness and excessive crying. The babies are very irritable. And they then will develop what we as categorize as GI symptoms, poor feeding. They have this excessive sucking behavior, but yet they can't coordinate swallowing, so weight loss is a big problem.

Huang: It sounds like these infants share a lot of the same symptoms as adults going through drug withdrawal.
Medlin: They do, and in some ways that's helpful because most of the moms have experienced some withdrawal themselves. And, to say, 'Remember how you felt when you went through this, this is likely is how your baby is feeling.' And they're very understanding of that and very cooperative with initiating treatment.

Huang: And is the treatment for infants the same as for adults?
Medlin: In some ways, yes. Now unfortunately there's no consensus across the country about what is the right medication to treat these babies with and every center treats them a little differently. It's felt that treating opiate withdrawal with an opiate is intuitive and is the appropriate medication. At Maine Med, we do things a little differently, we will use a sedative initially and if the babies develop increased symptoms, we will then add in the opiate. The disadvantage of using the opiate, the babies have to stay in the hospital as long as they are under treatment with the opiate.

Huang: How long do these babies experience withdrawal symptoms for? How long must they be treated?
Medlin: They can actually experience symptoms for up to 12 months. The focus of treatment is not to make the babies completely without symptoms of withdrawal. It's to get the babies comfortable enough so they can sleep well enough, feed well enough and can interact with caregivers. So generally babies who experience drug affects from maternal drug use or treatment programs will require treatment at the hosptial for for around 14 days or so and some will go home on a medication, the sedative, for a few more weeks. But the jitteriness and irritabilty-- they can last quite a while.

Huang: Aside from being born affected by drugs, do these infants, do they look very different from other babies? Are they born premature? Is there lower birth weight?
Medlin: That's a very good question. In mothers, who are in treatment programs, part of the reason for them to stay in treatment is they do have healthy babies who are most likely to be born at term. So staying in their programs, staying in treatment, is very important for these moms even if the downside is that they're going to have a baby who is affected by their medcations. Moms who go through seesaw of high, withdrawal, high, withdrawal, yes, those babies are born prematurely and are smaller for their gestational age. So it is really good for these moms to stay in their treatment.

Huang: So the state numbers show that there has been an increasing number of babies who, as the clinical term goes, are "drug affected." Are you seeing this in your own neonatal intensive care unit?
Medlin: Absolutely. In 2000, I believe that we saw a handful, maybe 12, 13. This past year, we saw over 100 babies who were either observed or treated.

Huang: And why do you think these numbers have risen so much? Why are you seeing so many more babies in your clinic?
Medlin: I think there are different factors. One is that there are a lot more clinics that have sprung up in the area to treat people with drug problems and because of that there are more moms who are in treatment so we probably see more simply because that draws people into the area. The other is that we're more aware of the problem and are more often asking the questions, looking for the signs of withdrawal and are more aware of the signs across the state.

Huang: So what is the long-term prospects to babies who are born with drug exposure in the womb?
Medlin: If you take into account socioeconomic factors and try to eliminate those from the picture, it appears that these babies, long-term have no different outcome than babies who are not born to moms who are affected. Due to that, the focus should always be on suppprting the families. Helping them with education, helping moms with and financial support is probably what we can do to improve the long-term outcomes of these babies more than focusing on the drug that they're withdrawing from.

Huang: Thank you very much.
Medlin: Thank you, Josie

Brenda Medlin takes care of many of these infants at Maine Medical Center in Portland.