WASHINGTON — Doctors and nurses at Community Hospital East in Indianapolis began to suspect in recent years that they were seeing more babies born dependent on opioids and other drugs.
Some infants shook and screamed with the pain of withdrawal. Others were born too small or had trouble breathing.
Now their suspicions are backed up by hard — albeit preliminary — evidence: One in five babies born at Community East in the first six months of 2016 tested positive for drugs. Opiates were the most common substance found in the umbilical cord.
The hospital tested only babies who appeared to be victims of substance abuse. Approximately 60 percent tested positive.
The figures come from a pilot study the Indiana State Department of Health is conducting under a 2014 mandate from the Indiana legislature. The mandate requires state health officials to create a task force to gauge the prevalence in Indiana of neonatal abstinence syndrome (NAS). Babies with the syndrome are exposed to addictive drugs while in the mother’s womb and go through withdrawal after being born.
Donetta Gee-Weiler, vice president of women’s and children’s services with Community Health Network, said the numbers are shocking but not surprising to those dealing with the issue every day.
“We’ve seen this and are working with the state to help others understand the incidence of substance abuse,” she said. “It’s a problem in Indiana.”
The NAS task force must come up with a standard way to diagnose and track the condition, and must help health care providers figure out how to prevent and treat it.
The four volunteer hospitals selected for the pilot — Community East, Schneck Medical Center in Seymour, Hendricks Regional Health in Danville and Columbus Regional Health — were chosen to represent urban, suburban and rural populations.
About 1 in 5 of the 301 umbilical cords tested from babies at those hospitals tested positive for opiates. That’s more than twice the national rate, according to the state Department of Health.
As with Community East, the other three hospitals tested only babies suspected of having been exposed to drugs in the womb. The state thinks more umbilical cords would test positive if all babies were tested.
The first six months of results provided by the state Department of Health don’t indicate the share of all newborns in the four hospitals who tested positive for a substance. Community East tracked that statistic for its own population.
Martha Allen, director of maternal and child health for the Department of Health, said the large difference between the state’s 20.6 percent positive opiate rate for cords tested and the national rate of 9.3 percent was surprising. But she said the sample size is too small to draw early conclusions.
“What it’s telling us right now is that we need to continue to study more,” Allen said. “There is a problem, and we need to figure out what the scale and scope of that is so we know how to address it.”
The state is adding five hospitals to the study. The next round of results is expected at the end of the year.
Nationally, admissions of drug-dependent babies into neonatal intensive care units nearly quadrupled from 2004 through 2013. By 2012, a baby suffering from opioid withdrawal was being born every 25 minutes.
State-by-state data are limited, the Centers for Disease Control and Prevention said in a report released Thursday on the 28 states — not including Indiana for which it had sufficient data. NAS rates increased significantly from 1999 to 2013 in nearly all of the states with at least three years of publicly available data.
Neonatal abstinence syndrome can be caused by exposure to alcohol and tranquilizers, such as Valium. But it’s most often the result of opioid use, such as heroin and prescription pain relievers.
The national opioid epidemic, driven by an increase in the prescribing of painkillers, has affected Indiana more than many states.
Indiana exceeded all but eight states in the number of pain prescriptions written per 100 people in 2012 — more than a bottle of pills for every Hoosier, according to the CDC.
And Indiana is one of four states where the drug overdose mortality rate has quadrupled since 1999.
Reid Health in Richmond has seen the number of opioid-addicted babies rise from one in 2010 to 54 last year.
But Indiana is not yet ready to require all hospitals to report cases of NAS, which only a few states mandate.
A task force survey of nurse managers at 91 Indiana birthing hospitals found that 40 percent of respondents didn’t have a policy related to diagnosing NAS.
One of the goals of the pilot, said Julia Tipton Hogan, executive director of the Indiana Perinatal Network, is to standardize the process “so everybody is at least starting the right way.”
“I imagine when we really start talking about these results, it’s going to scare everybody,” she said.
After Tennessee made it mandatory in 2013 for doctors and hospitals to report cases, the state found that, in most cases, mothers were getting at least one substance as a prescription through their health care providers, according to Kaiser Health News.
Before the reporting requirement, the only available data came from hospital discharge reports, which weren’t publicly available for 12 to 18 months.
Now there’s real-time reporting, said Bill Christian, a spokesman for the Tennessee Department of Health.
“Our hospitals have been very supportive of the requirement,” he said.
A problem with relying on discharge data is that infants might not show symptoms until after they’re home, Gee-Weiler said.
“People are looking at claims data and saying, ‘We don’t have a problem with NAS,’” she said.
Under the pilot program, umbilical cords of infants are tested only if the mother has tested positive through a urine screening, has said she used drugs or didn’t agree to be screened for drug use.
For the 301 newborns tested in the pilot hospitals during the first six months, opiates were the drugs most often found. And they were the drugs that reflected the biggest gaps between state and national rates of prevalence.
Indiana had a lower rate than the national prevalence for umbilical cords testing positive for methadone and buprenorphine, drugs used in medically assisted treatment programs for addicts.
Only five states rank lower than Indiana in the ability of opioid addicts to access buprenorphine, which reduces opioid cravings.
“Just like other states, Indiana is focused on making sure we have enough other treatment options for moms that seek that treatment,” Allen said. “So I anticipate over time that category will increase, because that’s what’s been seen in other states as they develop more treatment programs.”
Infants aren’t necessarily in withdrawal if their umbilical cords test positive for an opioid. To meet the state’s definition of NAS, a baby also has to exhibit specific symptoms.
“Every case I’ve seen is different as far as how the baby reacts, what works and what doesn’t,” said Ann Morrow, women and children clinical nurse specialist at Columbus Regional. “It’s a big learning curve for all of us.”
Slightly more than half of the babies born in Kentucky with NAS had symptoms severe enough to require treatment with morphine or another drug so they could get sufficient sleep and nutrition immediately after birth, according to a December report from the Kentucky Department of Health.
Kentucky started requiring hospitals to report NAS in 2014 and has been publishing annual reports since then.
Morrow said Columbus Regional was eager to be part of Indiana’s pilot program to get a handle on what the area’s needs are and how best to meet them.
But the state is still a long way from knowing “what our prevalence is and where are the pockets” of problems, she said.
When enough data come in, Gee-Weiler thinks it will further confirm that the opioid epidemic is touching every level of society, not just the low-income population that makes up a large part of the Community East patients.
“That’s the scary part,” she said. “Addiction is touching everyone.”
Email Maureen Groppe at firstname.lastname@example.org. Follow her on Twitter: @mgroppe.