The neonatal unit isn't supposed to be a drug rehab ward.

But the drugs their mothers took are causing more newborns in the Sacramento area to spend their first days of life suffering through the pains of withdrawal.

According to diagnosis reports from 2008 to 2010 submitted by hospitals to the state, the number of infants suffering withdrawal in the four-county area has doubled since the start of the decade.

Doctors diagnosed 156 local newborns with neonatal withdrawal syndrome from 2008 to 2010.

The syndrome generally occurs when mothers use drugs, particularly opiate painkillers, for an extended period during pregnancy. Its symptoms are similar to what addicts often experience when stopping a drug: sweating, fever, restlessness, poor appetite, vomiting and tremors.

While the syndrome is more prevalent, it is still rare, affecting one of every 450 local births in 2010, according to a Bee analysis of the data collected by the Office of Statewide Health Planning and Development.

More babies – about one of every 80 born in the region – are affected in some way by maternal drug use but do not suffer withdrawal symptoms, the state data show. That figure, which experts say underestimates the problem, has grown at a moderate pace for years, and doctors have reported a shift from cocaine toward narcotics.

Clinicians blame the rise in newborn drug withdrawal on increased use – and abuse – of prescription painkillers.

"We see a number of mothers using prescription drugs like Oxycontin and Vicodin – either recreationally or prescribed by doctors," said Dr. Angela Rosas, a pediatrician at Sutter Medical Center who focuses on child abuse.

Nationally, reports of neonatal withdrawal syndrome increased from 7,500 to 12,000 from 1995 to 2008, or seven times faster than the growth in total births, according to a new report in the medical journal Pediatrics. The report said that "an indeterminate part" of the rise is due to "more liberal use of prescription opiates."

In Northern California, the number of babies diagnosed with the syndrome has risen, but at a slower pace than in Sacramento.

Pregnant mothers often realize that abusing drugs could harm their infants, but cannot kick the habit. Jennifer Hohnholz, 34, of Rancho Cordova said she smoked crack cocaine in 2009 while pregnant with her third child.

"I felt horrible for doing it, because I knew I was pregnant," she said. She tried to stop but, "as soon as you see it, smell it, it would almost grab hold of you. It was like, 'I need this, and I'd rather be dead without it.' "

Hohnholz's child was born healthy but tested positive for drugs. The child was adopted and Hohnholz, who is now clean, hasn't seen her since.

"I do still wonder what she looks like," Hohnholz said. "The last time I saw her, she looked just like her grandmother. There's the regret and the feeling of 'How stupid are you, Jennifer?' "

Hospital stays are costly

Infants born with neonatal withdrawal syndrome regularly endure a long, expensive, painful hospital stay.

To reduce symptoms, doctors sometimes give newborns a dose of the drug they are addicted to, or something similar, and then wean the baby off it slowly, Rosas said.

"They can be quite sick," said Rosas.

The median length of hospital stay for local newborns with the syndrome is 10 days, compared to two days for births without complications, state data show.

The long stays are costly. The average hospital charge for these newborns was $110,000 in 2010, though agreements with insurance providers can significantly lower that amount.

Those charges cover the initial hospital stay. Many babies require follow-up care that might have been unnecessary if not for maternal drug use.

The public picks up most of the bill. Three-quarters of these newborns are covered by Medi-Cal, the state's insurance program for the poor.

By contrast, a one-year course of drug treatment for a pregnant woman, including residential care, costs about $20,000, said Barbara Thompson, executive director of the local branch of the National Council on Alcoholism and Drug Dependence.

Once the drug is out of its system, if there's been no damage in the first trimester, the fetus can be free of addiction, Thompson said.

Reporting has improved

Infant withdrawal, while painful, generally does not have a severe, long-term effect on infant health, so long as proper care is received, Rosas said. More concerning in the long run are other consequences of maternal drug abuse, particularly congenital abnormalities and developmental problems often associated with preterm birth.

Local newborns diagnosed with neonatal withdrawal syndrome in 2010 were twice as likely as other babies to be born prematurely, state data show.

Not everyone agrees the syndrome is a growing problem in the region. Sharon DiPirro-Beard, health program coordinator for the county Alcohol and Drug Services agency, said, "I think maybe some of these high numbers are because our hospitals do such a good job of reporting and we do a very good job providing services for this population."

DiPirro-Beard also said that abuse of prescription pain medication has had a "huge increase" in the past decade.

But Rosas, while noting that the statistics are only as good as the medical staff reporting them, said she and other doctors have seen an increase in cases of the syndrome. Doctors have long known of it, she said, and they have continuously used a standardized scale of symptoms for their diagnoses.

The increase in diagnoses of the syndrome occurred in each of the region's counties.

Illicit drug use is not always the cause of the syndrome. Doctors sometimes legitimately prescribe strong painkillers to expectant mothers suffering from an injury or painful pregnancy.

In these cases, Rosas said, doctors weigh weaning an infant off painkillers against the possible danger posed to the pregnancy if a mother remains in pain.

When the syndrome is caused by illicit drug use, the Child Abuse Prevention and Treatment Act of 2003 requires doctors to report it to child welfare.

"Sacramento is one of the few places in the country (which) has done a really good job" in identifying and reporting babies affected by drug abuse, said Nancy Young, director of Child and Family Futures, a public-policy research firm in Irvine that has a contract with the county.

But, Young said, the instances of drug abuse caught by hospitals remain "the tip of the iceberg."

Cuts affect programs

Compared to other large counties in the state, only Contra Costa had a higher rate of babies diagnosed with the syndrome than Sacramento in 2010, state data show.

The upward trend could continue as funding declines for local programs that find and treat pregnant addicts.

For 13 years, Sacramento County had a team of three social workers to address the problem of drug-exposed babies, but that unit was dissolved in 2010 budget cuts.

In 2007, several county agencies teamed with local hospitals to launch an effort called Partners Promoting Positive Pregnancy. They designed a screening form to identify pregnant moms at risk of delivering drug-affected babies, and urged physicians to use it.

Though the screening tool may still be in use, the county's work to promote it ended in 2010 for lack of funds.

Thompson's treatment program once had county funding to serve 100 mothers at a time for free, but budget cuts reduced it to 60 last summer.

Hohnholz, the former addict, went through the program and got clean. She recently completed a certificate in office administration, and is looking for work.

She gave birth to a healthy son, Jaden, 17 months ago.

"Getting clean, taking that first step, was the hardest thing I ever did," she said. "But the best thing I ever did."

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