The effects of maternal narcotic addiction on the newborn

Abstract

I N RECENT years the increased use of narcotics among teenagers and young adults has been widely publicized. Our attention was further focused on the problems of addiction when a local agency questioned the senior author on the possible effects of maternal morphinism on the newborn. As we searched for such cases and discussed this problem with other obstretricians and pediatricians we were able to find 10 cases of pregnancy complicated by drug addiction. Five of these women were admitted to the obstetrical service of the Morrisania City Hospital during the years 1951 to 1954. Since the effects of narcotic withdrawal were not always characteristic in the cases under our observation, we checked the standard texts in pediatrics and obstet,rics and the current literature, but were unable to gather much information. The United States Public Health Service and the World Health Organizat,ion at Geneva were contacted but they could offer us little help. Because of the paucity of available information we feel that a thorough review of this subject is timely. Table I lists the number of cases reported in the literature of infants delivered of narcotic-addicted mothers, the symptoms reported, and the therapy given. Some of the infants were entirely asymptomatic. Those infants who develop abstinence symptoms, however, show a characteristic syndrome. Most authors have reported that t,he infant appears normal at birth, but within 24 to 72 hours a progrcssivc restlessness ancl irritability begin. Accompanying the restlessness is a protracted shrill cry that may last for hours at a time ancl gives the impression that the infant is in pain. The infants feed poorly and the small amount of nourishment taken by mout,h is usually vomited. Other authors have reported that yawning and intermittent cyanosis are frequently seen. Diarrhea occurs and together with the pool intake causes inanition. The infants undergo severe dystrophy and may die in convulsions. Generally speaking, the symptoms prominent in the newborn arc very similar to those found in the abstinence syndrome of the adult. It is readily understandable how somatic requirements for opiates can be built up in the fetus. It is well known that morphine readily passes the placenta and produces varyin g degrees of asphyxia in utero as indicated by changes in rate and rhythm of the fetal heart. Shute ancl Davis 2o howcvcr, felt that individual susceptibility played an important role in tie effects of