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Faculty Highlights - Marie Hayes

In Maine, opiate drug abuse and addiction have increased dramatically in the past decade. Now a crisis reaching “epidemic proportions,” prenatal exposure to alcohol and opiates threatens the health and lives of an increasing number of infants in a growing demographic population.

Of the 77 infants admitted to EMMC’s Neonatal Intensive Care Unit with prenatal exposure to opiates in 2007, 90 percent were born to mothers in narcotics treatment at Acadia Hospital. Last year, almost a third of the infants in intensive care had opiate exposure, Hayes says.

Mothers who volunteer for Hayes’ studies are from Acadia Hospital and EMMC’s Center for Family Medicine — women who were or are in treatment for alcohol, drug and tobacco use, and those with a history of only tobacco and alcohol use.

In her research, Hayes found that mothers who were in a methadone withdrawal program when they became pregnant tended to have infants with less sleep fragmentation and better cognitive performance. Newborns of mothers not in treatment until after they became pregnant exhibited more interrupted sleep and poorer cognitive performance.

“The take-home message is mothers who enter treatment as early in pregnancy as possible and do not abuse alcohol during pregnancy stand a good chance for a healthy baby,” Hayes says. “The best thing an opiate-dependent mother can do for her unborn child is to get into a methadone treatment program. It’s going to protect the infant.”

Seventy percent of babies born to mothers with opiate addiction, including those in methadone programs, experience the same abstinence symptoms as adults. Withdrawal symptoms can begin in the first 48–72 hours after birth and last for weeks or months, interfering with neuronal and respiratory development, Hayes says.

In addition, the natural autonomic arousal systems that babies with immature respiratory systems develop to keep from falling into too deep — and potentially fatal — sleep can become suppressed with sleep deprivation. Sleep deprivation can produce exhaustion in the infant, resulting in decreased arousability, increased sleep apneas and decreased periodic sleep movements that regulate respiration.

Without sleep movement, an unattended, high-risk newborn may not wake up readily during apnea. The depression of movements may also decrease cardiorespiratory vigor, Hayes says.

“We think this scenario develops cumulatively,” she says, and is analogously “just like grandpa who sleeps through apnea and dies in his sleep.”

In the first few days following birth, sleep-related motor-movement bursts are found to correlate with newborn sleep deprivation, and the functioning of sleep and arousal systems. Hayes’ team also has found that high-risk infants show sleep fragmentation related to brain injury. The resulting sleep deprivation over time is associated with poor EEG-based cognitive performance.

In addition, with collaborator Dr. Mark Brown, chief of pediatrics at EMMC, the researchers are studying sleep movement and assessing neonatal abstinence syndrome, or opiate withdrawal.

Infants are followed for long-term neurocognitive assessment at Acadia Hospital. Hayes hopes the research will lead to developing new pharmacological treatments to protect neurological development in the newborn period.

Results of the work also are expected to inform better parenting skills for families in challenging socioeconomic environments who may be at risk for chemical or alcohol abuse, according to Hayes and Brown.

“These substances affect neural function,” says Hayes. “We want to assess infant risk for SIDS and brain injury related to prenatal exposures, but also assist in putting in place more interventions during the infancy period and beyond that would promote brain development for infants at risk for developmental disabilities.”

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