When mentioning drugs, most people immediately think of issues related to adolescents and adults. However, drug poisoning can also occur in newborns and even in fetuses. Fetal drug poisoning is a medical condition that warrants attention in children due to the potential for severe progression during the acute phase.
Primarily, it poses long-term risks, including physical impairments that lead to developmental delays, and particularly psychological damage that adversely affects the child’s future life.
What is Fetal Drug Poisoning?
Fetal drug poisoning, also known as neonatal drug withdrawal syndrome, is a passive drug poisoning that occurs when a mother uses addictive substances such as drugs or morphine during pregnancy, manifesting as withdrawal symptoms in the newborn after birth. The condition was first described in 1947, and since then, there have been numerous references in medical literature regarding cases of neonatal seizures associated with this syndrome.
Causes of Poisoning During the Fetal Period
During the fetal period, the newborn receives nutrients from the mother’s blood through the placenta. As a result, the child is affected by medications and chemicals that the mother consumes during pregnancy, specifically pain relief medications like morphine, cough suppressants like codeine, sleeping aids like phenobarbital, diazepam, and particularly, the risk of poisoning increases significantly with the regular use of addictive substances such as drugs and alcohol by the mother.
Changes in Organ Function in Newborns
Newborns have organ systems that are structurally and functionally immature compared to older children and adults, leading to significant differences in the absorption, distribution, metabolism, and excretion of toxic substances in their bodies. Firstly, absorption in newborns is slower, resulting in the accumulation of toxins and subsequent poisoning.
Secondly, newborns have fewer proteins to bind with these toxins, increasing the volume of distribution and raising the concentration of free toxins in the blood, leading to increased toxicity in the child’s body. Lastly, the liver and kidney functions in newborns are not fully developed, resulting in poor metabolism and excretion of toxins, extending the duration of toxicity. The consequences of altered organ function in newborns often lead to drug poisoning that affects multiple organs and has lasting implications for the child’s future.
Drugs That Cause Toxicity From the Fetal Stage
Drugs act on the central nervous system, specifically in the opioid receptor regions, where peptides known as enkephalins and endorphins function to regulate neurotransmission. In fetuses, drugs from the mother’s bloodstream enter the child through the placenta, reducing the secretion of enkephalins during the fetal period. After birth, the newborn is no longer nourished through the placenta, meaning no drugs enter the child’s body anymore. This sudden cessation of drug supply results in inadequate production of enkephalins, leading to increased nervous system activity and the emergence of stimulatory symptoms.
Signs and Symptoms
Although the condition originates during the fetal period, symptoms do not manifest immediately in newborns; they typically appear 4 days to even 4 weeks after birth. The first sign to recognize is persistent crying, characterized by high-pitched wails, facial flushing, and arching of the back. Prolonged crying can cause significant anxiety for parents.
If the condition appears early after birth, during the acute phase, it often manifests as tremors or even seizures. Seizures in newborns may go unnoticed if the child is tightly wrapped in a blanket and kept in a dark environment to minimize external stimuli.
During the acute phase, other symptoms may include fixed gaze, lethargy, sweating, skin flushing, and intermittent fever. In addition to neurological excitability, newborns with drug poisoning often sleep poorly due to disturbed sleep patterns. Furthermore, they may feed inadequately due to poor coordination between sucking and swallowing. As the condition worsens, rapid breathing and even respiratory failure may occur.
Diagnosis
Historically, fetal drug poisoning was often misdiagnosed as meningitis, brain hemorrhage, or metabolic disorders such as hypoglycemia or hypocalcemia, resulting in ineffective treatment and monitoring. The diagnosis of fetal drug poisoning primarily relies on maternal obstetric history, specifically whether the mother used drugs during pregnancy. Urine tests can reveal the presence of drugs, although urine tests only provide positive results within the first 4 days after birth.
Disease Progression
The symptoms of seizures during the acute phase can last for several days. With proper treatment and care, the child can recover without complications. After the acute phase, the child often regains an appetite due to the removal of inhibition from the feeding stimulus; however, other symptoms can persist for up to 8 weeks thereafter.
Long-Term Consequences
Children who experience fetal drug poisoning are often affected from the fetal stage, and these effects can continue to persist. If not properly monitored and cared for, this can adversely affect the child’s physical and psychological development later on:
– Physical Development: Children with fetal drug poisoning are at risk for poor physical development. Due to persistent crying, feeding difficulties, and poor sleep, caregivers need to be exceptionally patient. This situation can impact the psychological well-being of caregivers, causing them to feel anxious or pressured to care for the child, leading to inadequate care and nutrition. For children born to HIV-positive mothers, there is a higher risk of developing acquired immunodeficiency syndrome, necessitating careful monitoring.
– Psychological Development: When comparing children with fetal drug poisoning to those without, it is found that the former are at a higher risk of developing drug addiction later in life. Continued maternal drug addiction or living in a violent environment perpetuates issues impacting the child’s behavior, emotional development, and overall psychological growth, compounded by inadequate nutrition and education. These factors significantly affect the psychological development and positive community integration of the child.
Treatment Approaches
Fetal drug poisoning typically does not require specific medication treatment. Anticonvulsants are used in cases where the child experiences seizures, tremors, or severe agitation. Additionally, combining nutritional support with psychological therapy can protect the child’s mental health and aid in normal physical development. To prevent the condition from worsening, it is crucial to eliminate factors that may adversely impact the child’s psychology, such as stressful situations, threats to self-esteem, lack of affection, and feelings of insecurity. A nurturing and loving family environment is essential for the child’s well-being.
Currently, drug abuse is a complex social issue that poses significant concerns for society as a whole. Healthcare professionals must not only focus on preventive measures to avoid addiction and effective detoxification but also equip themselves with knowledge and resources for managing drug poisoning cases. Obstetrics and pediatrics should have specific plans in place for early detection of children at risk for drug poisoning during the prenatal phase, facilitating effective treatment, monitoring, and care for drug-related conditions and complications in newborns.
Dr. CK2. NGUYEN THI KIM THOA (Children’s Hospital No. 1 – Ho Chi Minh City)
