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US pledges better protection for babies born to addicts

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1679 (Published 22 March 2016) Cite this as: BMJ 2016;352:i1679
  1. Owen Dyer
  1. Montreal

The US federal government has promised a congressional committee that it will “take a more proactive approach” to enforce a 2003 law requiring states to report and protect drug affected newborns.

The Committee on Education and the Workforce launched a probe into failures to follow up neonates treated for opioid abstinence syndrome, after an investigation by the Reuters news agency last year found that the Keeping Children and Families Safe Act was being widely ignored by hospitals and state child protection agencies.1

The Reuters investigation reported over 110 deaths among children released from hospital after being treated for opioid addiction at birth, from data covering 23 states. Such babies have intense withdrawal symptoms in the first five weeks of life, but most recover completely from the syndrome within three months. The home environments they are discharged to, however, are often plagued by serious drug addiction and can pose danger.

The most common cause of death was smothering by mothers who fell asleep on their babies in a drug induced stupor. Another common cause was mothers inadvertently giving babies opioids, often methadone, or giving them the drug deliberately in an attempt to calm the infant. In one notorious Oklahoma case, a mother accidentally put her newborn in the washing machine with a pile of clothes and then passed out. In another case, a mother accidentally smothered her baby after crushing and injecting herself with painkillers given by her obstetrician.

The law requiring hospitals to report abstinence syndrome cases and requiring child services to follow the child was passed in 2003, early in the opioid epidemic that has gripped the United States. That year, 4991 babies had the syndrome diagnosed; the latest data showed 27 315 cases in 2013.

Only nine states have fully complied with the law, Reuters found. Most states have passed legislation requiring child services to be notified if parents test positive for illegal drugs but not if they have a valid opioid prescription or are on a methadone treatment program.

Several hospital doctors told Reuters that they were reluctant to report a mother who was on treatment and trying to get better. In some southern states, mothers who test positive for drugs frequently face imprisonment, which can also lead to reluctance in reporting.

And several mothers who are now in prison after the deaths of their babies through drug induced incidents told Reuters that they now wished that child services had become involved in their cases after discharge from hospital.

“It’s clear that the current system is failing some of our country’s most vulnerable children,” said John Kline, a Minnesota Republican representative who launched the congressional probe. He noted that no state had been penalised for its failures by a withdrawal of federal funds.

Sylvia Burwell, health and human services secretary, told the committee, “Specific actions are being taken where we have found there is wrongdoing,” adding that, after a review of several states, South Carolina was being placed on a “performance improvement plan.”

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