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New syndrome in newborns exposed to fentanyl possibly found
Physicians nationwide are reporting a constellation of severe birth defects in infants that may represent a new fetal syndrome associated with in utero fentanyl exposure. At least 10 cases have been confirmed so far, but experts believe many more may exist.
The first cluster of cases was identified at Nemours Children’s Health in Delaware. Genetic counselor Erin Wadman noticed an uncanny similarity across several affected babies she was consulting on. “I was sitting there in the appointment, and I was just like this face looks so familiar. This story sounds so familiar,” she said. Wadman and colleagues confirmed six infants with the same pattern of defects at their hospital. Additional cases were spotted in California, Massachusetts and Rhode Island.
The first cluster of cases was identified at Nemours Children’s Health in Delaware. Genetic counselor Erin Wadman noticed an uncanny similarity across several affected babies she was consulting on. “I was sitting there in the appointment, and I was just like this face looks so familiar. This story sounds so familiar,” she said. Wadman and colleagues confirmed six infants with the same pattern of defects at their hospital. Additional cases were spotted in California, Massachusetts and Rhode Island.
Distinctive Defects
The infants share remarkable physical similarities:
Some also have problems like heart defects and genital abnormalities. Critically, no genetic cause was found that would explain the pattern. But the mothers admitted to using illicit fentanyl and other street drugs during pregnancy.
- Cleft palate
- Unusually small heads and bodies
- Drooping eyelids
- Upturned noses
- Undersized lower jaws
- Abnormal foot alignment
- Webbed toes
- Feeding issues
Some also have problems like heart defects and genital abnormalities. Critically, no genetic cause was found that would explain the pattern. But the mothers admitted to using illicit fentanyl and other street drugs during pregnancy.
Plausible Link with Fentanyl
While evidence is still preliminary, lead author Dr. Karen Gripp says fentanyl disrupting fetal development is biologically plausible. Experts theorize it may severely disrupt cholesterol metabolism, which is essential for growth and organ formation.
“There is no proof yet linking fentanyl to the cases,” Gripp cautions. Other exposure factors like contaminants or polysubstance use could also contribute. Nonetheless, clinicians nationwide are now on high alert for similar cases.
“I may have seen more cases in the past but didn’t put 2 and 2 together,” said geneticist Dr. Howard Saal. The published cases motivated Saal to retrospectively evaluate whether past patients could have had related issues.
Answers Demanded
Researchers are actively investigating root causes from every angle. Blood samples will be analyzed to elucidate mechanisms. Genetics, purity, dosage responses and more will be scrutinized. The CDC reports about 3% of babies have birth defects annually, and so far this constellation of defects appears extremely rare.
But as Dr. Stephen Patrick emphasizes, these cases provide undeniable evidence that substance use during pregnancy can have devastating impacts. “This is a big public health crisis,” said Patrick. Reports show substance abuse and overdose deaths among pregnant women have skyrocketed.
For neonatologist Dr. Nora Volkow, the syndrome spotlights the vital need to support women’s health and understand how prenatal drug exposures affect fetal development. “These cases shed light on issues we must systematically investigate,” she said.
But as Dr. Stephen Patrick emphasizes, these cases provide undeniable evidence that substance use during pregnancy can have devastating impacts. “This is a big public health crisis,” said Patrick. Reports show substance abuse and overdose deaths among pregnant women have skyrocketed.
For neonatologist Dr. Nora Volkow, the syndrome spotlights the vital need to support women’s health and understand how prenatal drug exposures affect fetal development. “These cases shed light on issues we must systematically investigate,” she said.
Uncertain Futures
Critical questions remain about long-term outcomes for affected children. Lindsay Carlisle adopted one infant, Sammy, described in the case series. Now two years old, Sammy battles complex medical problems and lags developmentally.
“We don’t really know what this means for him cognitively…We’re just kind of winging it,” Carlisle says. Researchers aim to track the infants closely to provide families with insights on prognosis and services.
But Carlisle stresses that for the children themselves, questions of cause shrink beside the reality of their immediate needs. “I promised him I would give him the very best life that anyone could ever want from the day I met him,” she said.
Though much work remains to confirm links with illicit fentanyl, these initial cases powerfully epitomize the repercussions of the addiction epidemic facing society. They underscore the vital need for compassion and a public health approach focusing on women, families and frontline community support.
“We don’t really know what this means for him cognitively…We’re just kind of winging it,” Carlisle says. Researchers aim to track the infants closely to provide families with insights on prognosis and services.
But Carlisle stresses that for the children themselves, questions of cause shrink beside the reality of their immediate needs. “I promised him I would give him the very best life that anyone could ever want from the day I met him,” she said.
Though much work remains to confirm links with illicit fentanyl, these initial cases powerfully epitomize the repercussions of the addiction epidemic facing society. They underscore the vital need for compassion and a public health approach focusing on women, families and frontline community support.
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