The latest casualty figures from the drug war are worse than expected.
A new study at Hutzel Hospital in Detroit`s inner city, the most extensive in the nation to date, found that 42.7 percent of its newborn babies were exposed to drugs while in their mothers` wombs.
”We postulated about 20 percent,” said Dr. Enrique Ostrea, who headed the study. ”We were really surprised when it was more than 40 percent.”
Dr. Ira Chasnoff, president of the Chicago-based National Association for Perinatal Addiction Research and Education, said the Detroit findings
”reflect what we are seeing in places like Chicago, New York, Los Angeles, Washington and other cities with a major drug problem.”
About 8,000 babies are delivered at Hutzel each year. In the study, stool samples from 576 newborns were tested for derivatives of cocaine, heroin and marijuana. The drug-exposed babies ranged from showing no signs of impairment to suffering such severe difficulties that intensive-care treatment was needed to save their lives.
”We know these drugs cause handicaps, learning problems and other difficulties,” Ostrea said. ”You`re talking about a generation of children who will suffer.”
Even though Hutzel is a large, inner-city hospital that treats many patients from impoverished backgrounds, the results ”indicate a much more serious problem than we had imagined,” said Raj Wiener, director of the Michigan Department of Public Health.
”We are not talking about a medical problem. We are talking about a societal problem. We already know that children who get off to a bad start tend to have problems later in life. These babies have lost the battle before they were even born. If there is mental impairment or neurological damage, we are all in for a rough time.”
The National Institute on Drug Abuse estimates that as many as 10 percent of the pregnant women in the United States have used or are using cocaine. Some hospitals in urban areas with a severe drug problem put the figure much higher.
At Chicago`s Cook County Hospital, Dr. Rosita Pildes, chief of neonatology, estimated that 10 to 15 percent of the hospital`s newborns have been exposed to drugs, most commonly cocaine.
”Perhaps it is higher,” Pildes said, ”since we don`t routinely test the women unless there is a suspicion of drug abuse.”
Drug abuse during pregnancy, which more than doubles the risk of premature birth and low birth weight, has been shown to increase infant morbidity and now is a suspected cause of infant mortality.
Not all babies who have been exposed to drugs suffer adverse consequences, but officials at Hutzel Hospital estimate that 50 to 60 percent of the infants in the neonatal intensive care unit are there for drug-related problems.
They are among the saddest victims of the nation`s drug habit. Their shriveled bodies, sometimes weighing no more than a pound or two, bristle with tubes and wires connected to machines that breath for them, feed them and monitor their vital signs.
The nurses who work in this unit tell of teenaged mothers-some as young as 13 or 14-who walk out of the hospital after giving birth and never come back.
They also tell of nurturing these babies back to health, only to turn them over to drug-addled mothers with scant prospects of providing any sort of decent child-rearing environment.
”I know it sounds harsh,” said one nurse who has witnessed these wrenching tragedies, ”but I think we should offer these mothers a week`s supply of free drugs if they would let us take out their uterus.”
Hutzel`s 34-bed intensive-care unit for babies has been over capacity for much of the last two years. And even though nearly a dozen other metropolitan Detroit hospitals have similar advanced-care nurseries, overcrowding in Detroit has reached the point where some infants in need of intensive care-often unrelated to drug use-must be transported to hospitals in other cities.
Typical intensive-care costs for treating babies exposed to drugs range from $7,500 to $31,000, although it is not uncommon to see medical bills soar as high as $150,000, said Charles Thorne, director of budget and reimbursement at Hutzel. Since most of the mothers are indigent, the costs are borne by Medicaid.
Last November, Michigan residents voted to stop funding Medicaid abortions. Donna Cook, a nurse who is clinical manager of Hutzel`s neonatal intensive-care unit, said she thinks this has added to the number of drug babies.
”Many of these women would have had abortions,” Cook said. She also said that some drug-addicted women appear to be relying on crack cocaine, which is known to induce early labor, as a desperate, last-resort form of abortion.
Prosecutors in several states have begun to apply criminal statutes to women who use drugs during pregnancy.
In Illinois last May, Melanie Green, a 24-year-old Rockford woman whose baby died of cocaine-related causes two days after birth, was charged with manslaughter and delivery of a controlled substance to a minor. A Winnebago County grand jury dismissed the case, but lawmakers in Illinois and other states are considering measures that would make it easier to prosecute such cases.
Most medical experts agree that trying to place legal blame skirts the real dilemma. More urgent, they say, are the long-term needs of the estimated 300,000 children nationally who are born each year having been exposed to drugs.
Although the babies are generally drug-free soon after birth, researchers fear that exposure to drugs in the womb may result in long-term physical and mental impairment.
In Chicago, Chasnoff has been following the progress of 263 children whose mothers have admitted to drug use.
One striking abnormality observed by Dr. Chasnoff is that 2-year-olds exposed to drugs during pregnancy had smaller head circumferences than normal children that age. Smaller head size is thought to be a ”marker of risk” for long-term developmental difficulties, he said.
Chasnoff and other doctors are finding that the drug-exposed toddlers score poorly on developmental tests measuring abilities to interact with others and to cope with an unstructured environment.
”They had shorter attention spans and they were easily distracted,”
Chasnoff said. ”All of this tells us these children will be at risk when they get into the classroom.”
Researchers say it is too early to tell how much of the drug-related damage that occurs during pregnancy can be corrected, or whether the exposed children can ever recover completely. The unfavorable odds are lengthened by the chaotic and transient environment in which many of these children are raised.
Mothers of drug-affected children need intensive, follow-up training in nurturing and parenting, Chasnoff said. ”What we have to do,” he said, ”is provide the kind of active intervention and support that can improve the outcomes for these children.”
