'Momnibus' bill nears passage with change to require hospitals, birthing centers and midwives to offer perinatal palliative care

By Melissa Patrick
Kentucky Health News

A House-approved bill aimed at reducing maternal-mortality rates in Kentucky was approved without dissent by the Senate Health Services Committee on March 22 and sent to the Senate on the consent calendar, reserved for bills that are passed without debate.

State Rep. Kim Moser

"Kentucky has the ranking as second in the nation in maternal deaths in the year following childbirth," said the bill's sponsor, Rep. Kim Moser, R-Taylor Mill. "For this reason, we really started looking at some of the most significant problems and how to solve them."

Moser's House Bill 10 passed the House without disssent on March 5 and awaits a vote on the Senate floor with only six days left on the legislative calendar. 

The "Momnibus" bill would expand the Health Access Nurturing Development Services (HANDS) program and would allow the home-visitation program to be available up to three years after a child’s birth. It also would cover lactation consultation and needed equipment to encourage breastfeeding, and would educate mothers on the benefits of safe sleep for infants. These services would also be available via telehealth.

The bill would also ensure access to insurance coverage for pregnant women by adding pregnancy to the list of reasons a person would qualify for enrollment outside the normal open-enrollement period. This provision aims to help pregnant women address issues like obesity, diabetes and heart disease, all of which can cause complications and even death in pregnancy. 

"Deaths due to any of these factors are usually preventable," Moser said.

The bill would also address mental-health care by establishing a hotline for providers to get an immediate consultation for a mother in need of mental-health services. The hotline would be called Lifeline for Moms. It also aims to strengthen addiction services for those in need. 

"Our substance-use problem is one of the most significant issues," said Moser, noting that 53% of mothers who die in the year after childbirth "die from their substance abuse problem." 

The bill also has a provision to study doula programs and their benefit to those most at risk of poor maternal outcomes. Doulas provide moral, physical or other support in pregnancy, delivery and the postpartum period. 

What's in the committee substitute? 

The Senate committee substitute for the bill added language to require all hospitals, birthing centers and midwives to "provide or make referrals to a perinatal palliative care program, or perinatal palliative care support services" when there is a "prenatal diagnosis indicating that a baby may die before or after birth, diagnosis of fetal anomalies where the likelihood of long-term survival is uncertain or minimal or (the) newborn is diagnosed with a potentially life-limiting illness." The bill would also require this service to be covered by insurance. 

This addition comes from language in House Bill 467, sponsored by Rep. Nancy Tate, R-Brandenburg. It is titled the "Love Them Both Part II Act." Alex Acquisto of the Lexington Herald-Leader expands on the tension caused by HB 467 saying it is intended to offer "alternatives to pregnancy termination." 

Acquisto reports that "termination is one of the handful of options considered the standard of care health care providers present to patients with nonviable pregnancies," but with abortion illegal in Kentucky, this is not an option unless they go to another state for those services. 

Further, health care providers have told the Herald-Leader that such services already exist in hospitals across the state, thought not always in a formalized program.

HB 467 cleared the House Health Services Committee , which Moser chairs, on March 7. At that time, Kentucky Health News asked Moser, who is a primary co-sponsor of the bill, if she anticipated a greater need for perinatal palliative care since the state no longer allows abortions for nonviable pregnancies if there is cardiac activity present.

"I don't know that we're going to see a sudden uptick, but we just want to be available to moms and families," she said, adding later, "The intent is to provide support to a family who is dealing with a devastating diagnosis." 

The substitute bill would also require Safe Haven Baby Boxes to be staffed continuously by a licensed emergency-medical-services provider except when personnel are temporarily off-site providing emergency medical services. It also would require every public school to prominently display the Safe Haven Baby Boxes Crisis Line. This  language comes from House Bill 272, also sponsored by Tate.

House passes 'Momnibus' bill with measures for maternal health

Rep. Kim Moser speaks about her 'Momnibus' bill. (LRC photo)

By Isabella Sephaban
Kentucky Lantern

A maternal-health bill nicknamed “Momnibus’ was unanimously approved by the Kentucky House Tuesday after about 20 minutes of discussion.

The bipartisan House Bill 10 came out of a working group of Republican and Democratic women in the House and the Senate.

The Momnibus legislation would expand the Health Access Nurturing Development Services (HANDS) program and allow such home-visitation programs to be available up to three years after a child’s birth. It also would educate mothers on topics such as the benefits of breastfeeding, safe sleep for infants, and provide lactation consultation and equipment. These services would also be available via telehealth.

Supporters say Momnibus addresses Kentucky’s high rate of maternal deaths following childbirth.

Rep. Kimberly Poore Moser, the bill’s main sponsor, said “53 percent of women who die in the year following childbirth die as a result of their substance-use disorder.”

Other factors that increase maternal mortality include diabetes, heart disease and mental illness.

“These are all made more difficult during and after pregnancy, and can cause dangerous situations,” said Moser, a Republican from Taylor Mill in Northern Kentucky.

Although these situations are harmful and at times, even deadly, Moser said that “deaths due to any of these factors are usually preventable, and the ways to prevent these deaths are to identify and treat these diseases early in the pregnancy, if not before.”

“This is why prenatal care is so critical,” she said.

During their workgroup, Moser and her colleagues discovered that “there’s no structured mechanism to accessing mental health care quickly, in that Kentucky families lack support during the postpartum period to keep mothers, babies, and their families healthy.”

Momnibus aims to help decrease these high maternal mortality rates by ensuring access to insurance coverage for pregnant women.

Although there are special enrollment periods to buy insurance coverage for marriage, divorce, and fostering children, there are no special enrollment periods available for pregnancy, said Moser.

“A special enrollment period will allow pregnant women to purchase insurance coverage for pregnancy to get the care that she and her baby need during the prenatal period, for a healthy delivery, and during postpartum,” she said.

Momnibus also aims to address the lack of mental health care available to pregnant women by implementing a new psychiatric access program called Lifeline for Moms.

Moser said this program will establish “a hotline for providers to get an immediate consultation for a mother in need of mental health services.”

The lawmakers working on Momnibus have already applied and received a $750,000 grant to start implementing the program. This grant would be used to “specify the needed stakeholders to study birth and pregnancy outcomes, make recommendations to improve outcomes, provide oversight for the Lifeline for Moms program, and provide an annual report of their research and observations,” according to Moser.

The bill is in the Senate awaiting a committee assignment. Moser told Kentucky Health News that it will be handled by Sen. Julie Raque Adams, R-Louisville.

Bipartisan 'momnibus' bill aims to improve health of mothers, kids

State Rep. Kim Moser, a Republican from Taylor Mill in Northern Kentucky, spoke with other female legislators at a press conference Wednesday to announce their "Momnibus" bill. (Legislative photo)

Kentucky Health News

Legislators are accustomed to seeing "omnibus" bills that deal with many subjects, sometimes related, sometimes not. Now the Kentucky General Assembly has a "momnibus" bill intended to improve the health of children and mothers, including expectant ones.

House Bill 10 was developed by an informal, bipartisan group of female legislators concerned about the state's poor maternal health, said its main sponsor, Rep. Kim Moser, R-Taylor Mill.

"Addressing Kentucky's high maternal mortality rate and saving mothers and babies is obviously a priority for all of us," Moser said at a Wednesday press conference. Kentucky had the nation's sixth highest maternal death rate, 38.4 deaths per 100,000 live births, from 2018 through 2021. The national rate for that period was 23.5 per 100,000.

More than 90% of the state’s maternal deaths are preventable, Dr. Jeffrey M. Goldberg, legislative advocacy chair of the Kentucky chapter of the American College of Obstetricians and Gynecologists, told a state Senate committee last year. Just over 14 percent of Kentuckians lack access to adequate prenatal care, according to the March of Dimes.

Moser, a mother of five who was a neonatal intensive-care nurse, spoke from her own experiences: “I’ve really worked with mothers and babies and sick newborns, in their newborn phase, oftentimes through their first year, and I was able to really see some of the reasons for poor health disparities, especially in our poor areas of our state.”

Citing the advocacy group Every Mother Counts, Moser said “The leading causes of maternal death in the U.S. [are] lack of access to health care, including a shortage of caregivers, a lack of insurance, inadequate postpartum supports and certainly socioeconomic disparities, including the stress of racism and discrimination.” In Kentucky, she added, the risks are greater because of the prevalence of heart disease and diabetes.

HB 10 would:

• Add pregnancy to the list of "qualifying life events" that allow people to get health-insurance coverage outside normal enrolment, which could encourage more prenatal care.
• Create the Lifeline for Moms Psychiatry Access Program, for which Kentucky has received a $750,000 grant. Moser said she will also ask for an appropriation in the state budget “to make sure that’s a sustainable program.” It would be required to operate a hotline from 8 a.m. to 5 p.m. Mondays through Fridays.
• Expand the HANDS (Health Access Nurturing Development Services) home-visitation program for new and expectant parents to include breastfeeding counseling and assistance, education on safe sleep, as well as expanding the program to include telehealth, which Moser said she believes will help “reach moms in underserved areas or areas where she may have a transportation issue.”
• Require the Cabinet for Health and Family Services to study and make recommendations about the role of doulas, who provide assistance with the birth experience. 
• Strengthen an advisory council that provides policy guidance to increase collaboration, improve data collection, and suggest additional improvements.

Some Kentucky Republican legislators began paying more attention to such issues after the U.S. Supreme Court eliminated the federal right to abortion, activating a state "trigger law" that bans abortion except to save the mother's life or prevent permnent damage to a life-sustaining organ. 

"The wide gulf between abortion-rights and anti-abortion lawmakers was felt when Moser invited Addia Wuchner, executive director of the Kentucky Right to Life Association, to speak at the end of the press conference," reports Rebecca Grapevine of the Courier Journal. "That prompted most of the assembled Democratic lawmakers . . . to quietly walk out of the room."

State Rep. Sarah Stalker

One Democrat who remained, Rep. Sarah Stalker of Louisville, told the Courier Journal, "If we're going to force people to have children when they are not prepared to, when they are not ready to, when they are not interested in the family, it is critical that we give them the access to the health insurance . . . It doesn't help me and it doesn't help Kentucky, you know, Kentuckians at large and particularly women, to dig in my heels."

The second listed sponsor of the bill is Rep. Nancy Tate, R-Brandenburg, a leading anti-abortion legislator. Other Republican sponsors are Reps. Danny Bentkey of Russell, Emily Callaway of Louisville, Stephanie Dietz of Edgewood, Robert Duvall of Bowling Green, Ken Fleming of Louisville, Mark Hart of Falmouth, Kiom KIng of Harrodsburg, Amy Neighbors of Edmonton, Rebecca Raymer of Morgantown, Tom Smith of Corbin, Nick Wilson of Williamsburg and Susan Witten of Louisville.

Besides Stalker, the bill's Democratic sponsors are Reps. Lindsey Burke and Cherlynn Stevenson of Lexington. Democratic Reps. Lisa Willner of Louisivlle and Rachel Roberts of Newport initially attended the press conference but left and are not listed as sponsors.

Information for this story was also provided by the Kentucky Lantern.

2023 was a tough year in many ways, but saw significant positive developments in science and medicine, Washington Post reports

2023 saw new understanding and the start of a treatment

for dementia, as clinical trials cotinue at the University

of Kentucky and other sites. (iStock photo via Washington Post)

Kentucky Health News

Despite wars, the most mass killings since 2006 and the hottest average temperatures in human history, "2023 also was a year with significant positive developments, including in scientific research and medicine," The Washington Post reports, with a motive: "Research has indicated that uplifting news can provide an emotional buffer against distressing news and feelings of hopelessness — and even encourage optimism or action." Here are some things the Post listed:

The World Health Organization approved a new malaria vaccine that has been shown to be much more effective than the only previous vaccine against the potentially deadly disease. "The WHO said it expects the vaccine, which costs $2 to $4 per dose and has been shown to reduce symptomatic cases by 75 percent after three doses within a year, to be available by the middle of 2024," the Post reports. The U.S. has about 2,000 cases of malaria each year, most of them contracted in other nations.

The Food and Drug Administration approved the first pill to treat postpartum depression, which affects up to one in five womenand can cause "experience intense hopelessness and, in rare cases, psychosis — and it can last for years," the Post notes. "The new drug is taken once a day for two weeks and, unlike the existing treatment of an IV injection that may take as long as 60 hours to administer in a health-care setting, it can be taken at home."

The FDA also approved two gene-therapy treatments for sickle-cell disease, "a rare and debilitating condition that affects around 100,000 Americans, most of them Black. The disease causes extreme, constant pain and can drastically cut the life span of those affected," the Post notes. "Both are intensive, expensive procedures — and require chemotherapy, which has significant side effects. But patients who have received the treatments have spoken of its profoundly beneficial impact on their lives."

Scientists made progress in understanding dementia, the Post reports. One study "suggested that lifestyle habits, including regular mental and physical activity, eating a healthful diet, and regular social contact were linked with a slower rate of memory decline," the Post reports. "Another found that living in areas with more natural green spaces was associated with lower rates of hospital admissions for diseases including dementia, while separate research indicated that the use of hearing aids could cut the risk of cognitive decline by nearly half."

Meanwhile, the FDA approved, for the first time, to a drug that modestly slows Alzheimer’s disease. While difficult questions about safety, effectiveness and cost remain, many neurologists say that having a drug that slows Alzheimer’s is nonetheless a milestone after years of failed trials. The University of Kentucky is one of the sites of the clinical trials, and at last report was still seeking participants.

UK has $3 million grant to study impact of mothers' opioid use on babies; Ky. 3rd in rate of babies with opioid-withdrawal syndrome

Photo: healthychildren.org

By Lindsay Travis
University of Kentucky

A team of researchers at the University of Kentucky is working to better understand the impact of opioid-use disorder on mothers and babies.

Every 24 minutes in the United States, a baby is born with neonatal opioid withdrawal syndrome (NOWS) after being exposed via  a mother with opioid-use disorder.

In Kentucky, about 2 percent of babies born in 2020 had symptoms of NOWS — the third-highest rate in the U.S. In Appalachia Kentucky, that frequency increases to 7.7 percent — 77 of every 1,000 babies.

Early delivery can complicate pregnancies with opioid-use disorder and give children an increased risk of impaired neural development, including cognitive, motor, social and emotional abilities.

UK’s research team wants to understand how inflammation and dysregulation in the placenta caused by opioid use are linked to negative cognitive consequences in the baby.

The study titled “POPI: Placenta, Opioids and Perinatal Implications” is funded by a $3 million grant from the National Institute on Drug Abuse, part of the National Institutes of Health. Additional funding is possible, pending progress with the research.

Part of the research team, led by Ilhem Messaoudi, left
center (University of Kentucky photo by Jorge Castorena)

“This study is going to have a tremendous impact on Kentuckians, many of whom know first-hand the profound devastation opioid use has on the overall health of the commonwealth,” said Ilhem Messaoudi, chair of the Department of Microbiology, Immunology and Molecular Genetics in the College of Medicine and a principal investigator on the grant.

“NIDA specifically called for research on the placenta-brain axis — the idea that what happens during pregnancy and the placenta’s health will have long-term ramifications on the offspring, including brain development,” said Messaoudi. “The team assembled to find answers for our smallest Kentuckians all bring a variety of expertise to this study including to maternal-fetal medicine, pathology, neuroscience and neonatology.”

Pregnant women who seek care at UK HealthCare’s Perinatal Assistance and Treatment Home (PATHways) program will be eligible to enroll in the study. PATHways, a comprehensive treatment program, is designed to help pregnant and postpartum mothers who are living with substance use disorders.

“Kentucky has one of the highest maternal mortality rates in the country combined with a high rate of opioid use disorder. PATHways provides us a unique opportunity to support pregnant mothers and invest in those lives through this kind of project that blends a variety of scientific specializations,” said Dr. John O’Brien, chief of the Division of Maternal-Fetal Medicine at UK HealthCare, a professor in the Department of Obstetrics and Gynecology in the College of Medicine and co-principal investigator on the grant.

As part of the study, researchers will collect ultrasound data, blood samples, the placenta and umbilical cord blood and conduct neurodevelopment assessment on babies for one year after birth. The data will help them determine the impact of maternal opioid use disorder on both the health of the placenta and the baby’s brain.

“In previous studies, using a rat model, we’ve learned maternal opioid use disorder increases inflammation in the brain and alters microglia — cells that are like the housekeepers of the brain,” Messaoudi said. “The alteration can affect the way the brain continues to develop.”

Investigators can measure that change in the brain through another type of immune cells found in the blood, called monocytes. The team will track neurobehavioral outcomes through a series of assessments in the newborn period and at age 3, 6 and 12 months.

O'Brien said, “Our hope is this research project will provide health-care professionals the knowledge and evidence necessary to improve the care of pregnant mothers with opioid use disorder, reduce risks and optimize neonatal outcomes.”

The study also includes researchers in the College of Medicine’s departments of Pediatrics and Pathology and Laboratory Medicine, as well as the Spinal Cord and Brain Injury Research Center and the Dr. Bing Zhang Department of Statistics in the College of Arts and Sciences.

If you or someone you know is pregnant and dealing with substance-use disorder, contact UK's Polk-Dalton Clinic at 859-218-6165 to make an appointment for prenatal care.

Kentucky health insurers give $750,000 to Louisville public-benefit firm to improve care for opioid-exposed infants in rural Kentucky

NAS stands for neonatal abstinence syndrome.

By Melissa Patrick
Kentucky Health News

The Kentucky Association of Health Plans, the trade group for companies selling health insurance in Kentucky, has given $750,000 to Nascend, a Louisvile-based public-benefit corporation that works to help infants with neonatal abstinence syndrome, caused by mothers using opioids during pregnancy. 

The KAHP grant will allow Nascend to extend its certification program to rural hospitals in Kentucky, to help standardize and improve care for opioid-exposed infants across the state, a news release said.

“Kentucky’s Medicaid managed-care organizations are proud to partner with Nascend . . . to show demonstrable results by eliminating care gaps and improving health outcomes for mothers and babies,” KAHP Vice President of External Affairs Katherine Kington North said in the release.

The NAS certification program is designed to help health-care providers treat substance-exposed infants more effectively and efficiently, which ultimately leads to better outcomes for the children and families as well as savings to the health care system, the release said. 

Dr. K. Dawn Forbes, founder and CEO of Nascend, said her team of neonatologists is excited about the impact that this grant will have across the state, particularly in rural areas. 

“We are going to be able to address a lack of standardized care guidelines, outdated and ineffective infant assessment tools, overused medication treatment, poor parental engagement, and insufficient nutrition," Forbes said in the release. "This is a game-changer, and we appreciate Kentucky health plans for being laser-focused on improving the social determinants of health.”

Kentucky has been particularly affected by the opioid epidemic, with NAS rates reaching 19.4 per 1,000 infants, with a peak rate of 77 per 1,000 infants in the state's Appalachian region. The national average is only 7 per 1,000.

The release says the KAHP grant will "help decrease the need to transfer infants to facilities in urban areas, better maintain patient-provider relationships, reduce family stress, and retain care and resources locally while also contributing to an estimated cost savings of at least $2.83 million annually by serving a minimum of 500 infants per year at full implementation." 

Nascend says it has trained more than 7,000 health-care providers in 38 states and improved the lives of more than 1.6 million infants. The company was recognized this year as a "Top 10 Health Education Services Provider" by Healthcare Business Review, and received the "Top Social Impact Company Award" at the 2023 Canopy Annual Good Business Summit for "aligning purpose and value with community impact," a news release said. 

Marijuana is often used during pregnancy, but it can get the child off to a lower-than-average start on development and health

Image from Nexstar Media

Users and sellers of marijuana may suggest that expectant mothers use it to alleviate side effects of pregnancy, especially morning sickness, and research has found that it is the drug most commonly used during pregnancy. But other research increasingly shows "adverse outcomes for children when cannabinoids are consumed during pregnancy," says a study published in Frontiers in Pediatrics.

"Even with marijuana use limited to the first trimester of pregnancy, we demonstrate a noteworthy average reduction in birth weight of over 150 grams," more than 5 ounces, said Dr. Beth Bailey, director of population health research at Central Michigan University and senior author of the study. "Furthermore, if marijuana use persisted into the second trimester, a significant decrease in newborn head circumference was observed."

That matters, said Dr. Phoebe Dodge, the study's first author: "Newborn size serves as a robust indicator of future child health and development."

Other studies "have provided compelling evidence regarding the substantial impact of cannabis use on newborn size," the journal reports. "The most pronounced deficits in size were observed among infants exposed to marijuana throughout the entire gestational period," Bailey said. "Infants exposed to cannabis throughout pregnancy exhibited a reduction in birth weight of approximately 200 grams and a decrease in head circumference of nearly 1 centimeter," just under 0.4 inch.

"The research revealed that even occasional use, such as for managing first-trimester morning sickness, can lead to reduced fetal growth similar to the effects seen with continued cannabis use throughout pregnancy," the journal reports. 

That said, the study authors didn't know just how much or how often the participants used marijuana, just whether or not they did at all So, they could not "establish a direct correlation between heavy cannabis use and more pronounced outcomes in newborn growth," the journal reported.

But Dodge emphasized, "The best course of action is for women to be advised to cease marijuana use prior to conception." If you're already become pregnant, "The second-best option is to quit as soon as possible in order to mitigate potential long-term adverse health and developmental consequences."

The Centers for Disease Control and Prevention has more information.

Parents in 21 more counties get CPR kits for infants, for total of 32; hundreds still available, with money from health insurers

The CPR Anytime® training kits are given to parents.

Three times as many Kentucky counties will get cardiopulmonary resuscitation kits for infants, funded by the Kentucky Association of Health Plans, representing health-insurance companies in the state.

The American Heart Association is delivering the life-saving CPR kits to health-care facilities to give to new parents. Each kit includes an inflatable mannikin and video that teaches infant CPR in as little as 20 minutes.
 
The initiative, launched in May 2022, has provided 3,000 kits to neonatal intensive-care units in 11 counties. A $150,000 grant from KAHP is funding 4,350 more kits, nearly 2,500 of which have been distributed in 21 counties: Bath, Bell, Boyd, Casey, Clark, Estill, Floyd, Garrard, Harlan, Hyden, Jackson, Johnson, Madison, Montgomery, Nicholas, Perry, Pike, Powell, Rockcastle, Rowan, and Warren.

“Rural communities often face a critical shortage of health-care professionals,” said Ashley Sokoler, AHA's Kentuckiana director. “That’s why it’s so important to make CPR training available to new parents in rural areas and provide the healthcare facilities they visit with the resources needed to implement training without causing additional strain on their staff.”

Hospitals, clinics, and other healthcare providers interested in requesting kits can contact AHA Kentuckiana Community Impact Director Tracy Monks at tracy.monks@heart.org for information.

Kentucky's intensive-care units will give new parents insurer-funded kits so new parents can learn how to give CPR to infants

Training kit for giving infants cardiopulmonary resuscitation

The Kentuckiana American Heart Association and the Kentucky Association of Health Plans, the association for companies selling and managing health insurance in the state, and have introduced a new initiative to equip thousands of new Kentucky parents with kits to teach them how to give cardiopulmonary resuscitation to an infant. 

The initiative is funded by a $95,000 grant from KAHP. The AHA will distribute 3,000 Infant CPR Anytime Training® Kits to newborn intensive-care units throughout the state. The kits include an inflatable manikin along with a video course designed to provide infant choking and CPR training in about 20 minutes. 

 “We’re excited to provide funding for this partnership with the American Heart Association. This is an extremely effective tool that will increase the chances of survival in the face of an emergency and equip new parents with the confidence to administer lifesaving techniques," Katherine Kington North, director of external affairs for KAHP, said in a news release.

 

The release notes that the at-home kits will fill voids created by staffing problems related to the Covid-19 pandemic. They will be available in English and Spanish. The AHA began deliveries of the kits in mid-May, with 1,900 distributed to date, says the release. The KAHP gift capped off National CPR Awareness Week, which ran from June 1-7 this year.

“With preterm infants, there are twice as many cardiovascular malformations as those born at full term, so the kits are especially important to those families,” Dr. Sandra Guerra, chief medical director for KAHP member WellCare of Kentucky and board chair of the Kentuckiana AHA, said in the release. 

She added, “Premature infants may also have breathing difficulties due to an underdeveloped respiratory system, and should it be necessary, parents will have the know-how to administer aid before an ambulance arrives. The physical practice that these kits provide is tremendous.”

In 2020, there were 5,705 preterm births in Kentucky, representing 11% of live births, according to the March of Dimes.

Covid-19 infection in pregnancy, even with no symptoms, could harm a developing baby, research at UK College of Medicine finds

By Elizabeth Chapin
University of Kentucky

Covid-19 infection during pregnancy, even with no symptoms, could still have potential long-term consequences for a developing baby, according to a new University of Kentucky College of Medicine study.

UK staff scientist Brianna Doratt and Ihlem Messoudi,
Ph.D., right, in their lab (UK photo by Mark Cornelison)

The study led by Ilhem Messoudi, chair of the Department of Microbiology, Immunology and Molecular Genetics, was published in Cell Reports May 25. It shows that Covid infection in pregnant mothers who had no symptoms or mild symptoms still triggered immune responses that caused inflammation in the placenta.

“Prior to this study, this response was only thought to occur in severe Covid-19 cases,” said Messaoudi. “We now know that even a mild infection that doesn’t even register with a patient is still being registered by the maternal immune system. The placenta had very clear signs of having sensed that there was an infection.”

Because the placenta protects a developing fetus from many pathogens, transmission of viruses between mother and baby is extremely rare. The greatest risk for a fetus is how the mother’s immune system responds to the virus.

Immune responses triggering inflammation of the placenta can be linked to adverse pregnancy outcomes including pre-term labor and pre-eclampsia, as well as neonatal complications due to reduced immune function of the baby, Messaoudi says.

Messaoudi’s team analyzed immune cells in placenta tissue and blood from pregnant mothers who tested positive for the coronavirus. Samples from women with no symptoms or mild symptoms were compared to those without infection.

They found that patients testing positive had activated T-cells, an immune response, they had reduced levels of specialized macrophage cells that regulate the tissue. The immune cells in the placenta were “rewired” in a way that made the tissue more prone to inflammation.

The findings add to scientists’ growing understanding of the maternal immune system's relationship with the virus and will help lead to future studies on potential long-term impacts for mothers and babies.

“This tells us how capable the maternal immune system is … while at the same time shows how detrimental Covid-19 can be even when the infection is not severe,” Messaoudi said. “These are all reasons why it’s so important that pregnant mothers get vaccinated.”

Crusade for Children grants help 3 CHI St. Joseph hospitals

The WHAS Crusade for Children has given the Saint Joseph London Foundation $100,000 to establish a Level II neonatal intensive care unit at Saint Joseph London hospital. The unit will be one of only two Level II NICUs in southeastern Kentucky.

The unit “will be equipped to continue providing the best care to infants affected by premature birth, neonatal abstinence syndrome, fetal anomaly and respiratory disease,” said Leslie Buddeke Smart, president of the foundation.

The crusade also gave the foundation $36,000 to enhance patient care in the NICU and birthing center at the Women’s Hospital at Saint Joseph East in Louisville, and $35,000 to the Flaget Memorial Hospital Foundation to make its emergency department and operating rooms at Flaget Memorial Hospital more accommodating for young children. The Bardstown hospital gets more than 4,000 visits from children each year, CHI St. Joseph Health said in a news release.

FDA proposes new, graphic warnings for cigarette packs and ads

A Food and Drug Administration photo illustration shows three  of the 13 proposed warnings.

The Food and Drug Administration has again published a proposed rule to "require color graphics depicting the negative health consequences of smoking be added to cigarette packages and in cigarette advertisements," Inside Health Policy's Beth Wang reports.

The warnings would be the first update to cigarette package warnings in more than 30 years. They were authorized by a 2009 law, but a tobacco-company lawsuit blocked FDA's first attempt.

Wang describes the proposed warnings:

“Tobacco smoke can harm your children,” with an image that shows the head and shoulders of a boy 8 to 10 years old, wearing a hospital gown and receiving a nebulizer treatment for chronic asthma.

“Tobacco smoke causes fatal lung disease in nonsmokers,” with an image showing gloved hands holding a pair of diseased lungs containing cancerous lesions.

“Smoking causes head and neck cancer,” with an image showing the head and neck of a woman 50 to 60 years old who has a tumor protruding from the right side of her neck, just below her jawline.

“Smoking causes bladder cancer, which can lead to bloody urine,” with an image of a gloved hand holding a specimen cup with bloody urine.

“Smoking during pregnancy stunts fetal growth,” with an image of an infant on a medical scale with a digital display reading 4 pounds.

“Smoking can cause heart disease and strokes by clogging arteries,” with an image of a 60- to 70-year-old man with a large, recently sutured incision in his chest as he undergoes monitoring.

“Smoking causes COPD, a lung disease that can be fatal.” There are two versions of the COPD warning. One will have an image of gloved hands holding a pair of diseased, darkened lungs removed from a smoker; the other will have an image of the head and neck of a 50- to 60-year-old man who has a nasal canula under his nose supplying oxygen, with the oxygen tank behind him.

“Smoking reduces blood flow, which can cause erectile dysfunction,” with an image of a 50- to 60-year-old man sitting on the edge of a bed and leaning forward with one elbow resting on each knee. The man’s head is tilted down with his forehead pressed into the knuckles of his right hand while his female partner sits behind him on the bed, looking in another direction.

“Smoking reduces blood flow to the limbs, which can require amputation,” with an image of feet with several toes amputated due to damage resulting from peripheral vascular disease caused by smoking.

“Smoking causes type 2 diabetes, which raises blood sugar,” with n image of a personal glucometer device showing a high blood sugar level.

“Smoking causes age-related macular degeneration, which can lead to blindness,” with the image of a senior man getting an injection in his right eye to prevent additional macular degeneration.

“Smoking causes cataracts, which can lead to blindness,” with the image of a man who is at least 65 years old who has a cataract covering his right pupil.

A lawsuit by public-health and anti-smoking advocates prompted FDA to issue the proposal, Wang notes: "The proposed warnings are required by law to be displayed on half the front and rear panels of cigarette packages, and on the top 20% of the area at the top of advertisements.

"This marks the second time FDA has issued a proposed rule to require graphic warnings on cigarette labels and advertisements," Wang notes. "The first rule was blocked in 2012 by the U.S. Court of Appeals for the District of Columbia in R.J. Reynolds Tobacco Company v. FDA, which argued the proposed rule violated the First Amendment by not justifying why there is a need to issue regulation on commercial speech. In March, however, a federal court ordered FDA to issue the proposed rule by Aug. 15, and a final rule by March 15, 2020."

The Family Smoking Prevention and Tobacco Control Act of 2009 "required nine new health warning statements to be included on cigarette packages and in cigarette advertisements, and it directed FDA to develop color graphics depicting the negative health consequences of smoking to accompany warnings," Wang notes. "After having their initial proposed rule rejected by the court in 2012, FDA undertook a research and development process to consider whether the TCA’s textual warning statements would promote greater public understanding of the risks associated with smoking. Through that process, FDA determined there was support to propose adjusting some of the TCA statements. FDA ended up with 16 statement-and-image pairings to test in a final quantitative consumer research study, which resulted in the 13 cigarette graphic health warnings listed in the proposed rule."

Specialists give parent-education campaigns credit for big decline in Sudden Infant Death Syndrome in Kentucky

Fewer babies in Kentucky are dying from Sudden Infant Death Syndrome, and wellness specialists are crediting a multi-pronged educational campaign by hospitals and other health-care providers, reports Ann Bowdan of Louisville's WLKY-TV.

In 2016, 103 Kentucky children died of SIDS. By 2018 the number had dropped by more than half, to 49.

"We have done everything from teaching in our prenatal classes, there is literature that goes home, it’s on our website," Norton's Children's Hospital wellness specialist Erkia Janes told Bowdan. "It’s seeped through every class we have."

For many years, parents were given the wrong advice, "For decades, it was thought a baby sleeping on its back could choke on reflux, or vomiting," Bowdan reports. "But in 1994 the American Academy of Pediatrics reversed that way of thinking," based on research. Janes said, "The research clearly shows that a baby on their belly is desperately as risk for SIDS."

The educational materials use "ABC" to describe how a baby should sleep: "alone, on your back, in a safe crib," Janes said. "Meaning no blankets, bumpers, and no sleeping in a bed with parents."

Study finds 9.2% drop in annual rate of opioid-overdose deaths from November 2017 to March 2018 in Ky., nearly 3% in U.S.

By Melissa Patrick
Kentucky Health News

As national and state reports showed the number of deaths related to opioids may be at a plateau, or declining, President Donald Trump has signed a comprehensive, bipartisan opioid bill that includes both law-enforcement and public-health measures.

"Together we are going to end the scourge of drug addiction in America," Trump said Oct. 24. "We are either going to end it or we are going to make an extremely big dent in this terrible, terrible problem."

CDC graphic

The Centers for Disease Control and Prevention's preliminary data shows that the 12 month period ending March 2018, the most recent data compiled, saw a decline of nearly 3 percent in the number of reported overdose deaths, to 68,690, when compared to the 12 month period ending November 2017, when the number of overdose deaths was at its highest ever, 70,780.

The same CDC report shows an even greater drop in Kentucky of 9.2 percent. In the 12-month period ending November 2017, Kentucky reported 1,594 overdose deaths -- also its peak-- and in the 12-month period ending in March of this year, it reported 1,446 deaths.

Kentucky Injury Prevention and Research Center graphic

A preliminary report from the Kentucky Injury Prevention and Research Center also shows a drop in overdose deaths in Kentucky between the last quarter of 2017 and the first quarter of 2018, with declines in deaths involving fentanyl and heroin, but not in the number of deaths involving methamphetamine.

KIPRC's provisional data shows that between the fourth quarter of 2017 and the first quarter of 2018 the total number of overdose deaths dropped from 366 to 344; heroin-related OD deaths dropped from 57 to 44; fentanyl-involved OD deaths dropped from 187 to 180; and ODs involving methamphetamine increased from 79 to 82.

In his prepared remarks for the Oct. 23 Milken Institute healthcare summit, the nation's top health official was cautiously optimistic about the CDC report and referred to the results as a plateau.

"Plateauing at such a high level is hardly an opportunity to declare victory," said Health and Human Services Secretary Alex Azar. "But the concerted efforts of communities across America are beginning to turn the tide."

Paige Winfield Cunningham of The Washington Post lists five measures of the opioid crisis:

1. Overdose deaths: While the new law and the CDC report offer a glimmer of hope, the grim reality is that in 2017 nearly 72,000 people died from an overdose death, and almost 50,000 of them were from opioids. In Kentucky, 1,565 people died from a drug overdose in 2017, an 11.5 percent increase from the prior year.

2. Number of opioid prescriptions: According to the CDC, opioid-prescription rates fell last year to the lowest level in a decade, 58.7 prescriptions per 100 people.

The firm IQVIA reported in August that there has been a 22 percent decrease in opioid prescriptions nationally between 2013 and 2017, but other studies don't show this decrease, Cunningham reports, noting a Mayo Clinic report in August that said little had changed in the past five years on the prescribing front. "Researchers found that while prescriptions seemed to be leveling off, they weren’t decreasing among most groups of patients," she writes.

CDC map shows ranges of opioid prescribing by state in 2017

The CDC report shows the number of opioid prescriptions dispensed in Kentucky is also dropping, but the state's rate is still higher than the national rate at its very highest in 2012 -- 81.3 prescriptions per 100 people. Kentucky's rate in 2017 was 86.9 prescriptions per 100. The peak in Kentucky was in 2011 at 137 per 100.

Between 2011 and 2016, 70 million fewer opioid prescriptions have been dispensed in Kentucky, according to a 2017 state report.

Toward the goal of decreasing opioid prescriptions, Kentucky passed a law in 2017 to limit most painkillers to a three-day supply for acute pain, but it also came with a long list of exemptions.

3. Prescribing rates for drugs that reverse overdoses or that are used in medication-assisted therapies for addiction: Azar said that since January 2017, the number of patients receiving buprenorphine and naltrexone, medications to treat opioid abuse, has increased by 21 percent and 47 percent, respectively. And the number of prescriptions dispensed monthly for naloxone, often sold under the brand name Narcan, has increased 368 percent.

In Kentucky, an Urban Institute analysis found that the number of annual units reimbursed by Medicaid for buprenorphine rose 382 percent from 2011 to 2017, from 2 million units to 9.8 million respectively. During that time, the number of annual naltrexone unites increased 502 percent, and naloxone jumped 709 percent. (The 2017 numbers are projected, meaning that they include data from only the first two quarters of the year, which have been extrapolated to an annual figure.)

The analysis shows the biggest jump in Kentucky's Medicaid reimbursements for all of these drugs happened between 2013 and 2014, when the the state expanded Medicaid to those earning up to 138 percent of the federal poverty level under the Patient Protection and Affordable Care Act. For example, the number of units of buprenorphine rose 108 percent, from 3.2 million units to 6.7 million units.

In 2015, Kentucky permits certified pharmacists to dispense naloxone under a physician-approved protocol. A map on KyStopOverdoses.ky.gov shows more than 372 pharmacies across the state that distribute Narcan and the interactive website allows a person to type in a ZIP code to find the closest location. Naloxone does not require prescription in Kentucky.

Dr. Michelle Lofwall, a University of Kentucky psychiatry professor and part of the College of Medicine Center on Drug and Alcohol Research, told the UK Board of Trustees Oct. 8, at a day-long meeting dedicated to opioids, that the need for medication-assisted treatments remains great.

She said only 20 percent of persons with opioid-use disorder get any sort of specialty addiction treatment and among those, only 37 percent receive these FDA-approved medications. She said the main reasons for this are stigma, discrimination and concerns about diversion of drugs to illegal use.

4. Number of babies born addicted to opioids (neonatal abstinence syndrome): Using its most recent statistics available, the CDC says the incidence of NAS increased about 400 percent nationally from 2000 to 2012.

Kentucky Department for Public Health graphic

"By 2012, on average, one NAS-affected infant was born every 25 minutes in the United States," says the CDC.

Kentucky saw a slight drop in the number of reported NAS babies in 2016 to 1257 from 1,354 in 2015, which amounts to about 100 per month, according to a state Department for Public Health report.

5. Fentanyl and heroin deaths: Fentanyl is a synthetic opioid that is at least 50 times stronger than heroin and is often mixed with other drugs. It is a leading cause of overdose deaths.

The provisional CDC data estimated there were more than 27,000 reported synthetic-opioid overdose deaths in the 12 months through September 2017 and nearly 29,000 such deaths in the 12 months through March 2018. Reported heroin-overdose deaths dropped from 15,983 to 14,964.

In Kentucky, fentanyl was involved in 52 percent of the state's 1,565 deaths in 2017, up from 47 percent in 2016, according to the annual Kentucky Office of Drug Control Policy report. About 22 percent of the deaths involved heroin, down from 34 percent in 2016.

Kentucky has very high rate of addicted mothers; rose by double-digit percentages early in decade, seemed to level off in 2015-16

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky has had a very high rate of opioid-use disorder among women delivering babies in hospitals, according to a study published by the Centers for Disease Control and Prevention.

In Kentucky, 19.3 mothers out of every 1,000 who gave birth in a hospital in 2014 had an opioid-use disorder. Among the 30 states studied, only two were ahead of Kentucky: Vermont, at 48.6 per 1,000, and West Virginia at 32.1. The national rate is 6.5 per 1,000. West Virginia was the only state adjoining Kentucky to be included in the study.

Opioid use during pregnancy, whether it be heroin, prescription painkillers or some other narcotic, is associated with pre-term labor, stillbirth, neonatal abstinence syndrome and maternal death.

The study, published Aug. 10 in CDC's Morbidity and Mortality Weekly Report, analyzed hospital discharge data from 1999 through 2014. Over that time, the national rate of mothers with opioid-use disorders at delivery more than quadrupled, going from 1.5 to 6.5 cases per 1,000.

Kentucky's rate showed big jumps from 2010 through 2014, going from 7.2 to 9.5 to 14 to 15.7 to 19.3. Over the same five years, the national rate rose from 3.9 to 6.5 per 1,000. The Kentucky numbers represented annual increases of 32, 43, 5 and 23 percent.

Kentucky neonatal abstinence syndrome cases. Ky. Dept. for Public Health graphic.

The researchers say that while their study is the first multi-state look at the prevalence of opioid-use disorder diagnosis among women giving birth, this data is "mostly consistent" with  neonatal abstinence syndrome studies between 1999 and 2013 and correlates with state opioid prescribing rates in the general population. They add that the increasing trends could also be a result of improved screening and diagnosis.

Hospital-discharge data for babies born with neonatal abstinence syndrome for 2015 and 2016 show increases of only 2.9 and 2.2 percent in Kentucky, indicating that the problem did not worsen during these years, compared to the five years before that, but remains very bad. 

Additional surveillance by the state Department for Public Health showed more babies were born with neonatal abstinence syndrome at birth than the hospital-discharge data showed, but also showed a decrease in that number from 2015 to 2016.

Precise reporting of the problem can be a challenge, due to the stigma it carries and different state laws on reporting.

As of July, eight states required health-care professionals to test for prenatal drug exposure when it is suspected, and 24 states and the District of Columbia require professionals to report suspected use among pregnant women. Twenty-three states and D.C. consider substance use during pregnancy to be child abuse, and three states consider it to be grounds for admitting a woman involuntarily into a psychiatric hospital. The researchers note that these strict policies could cause women to try to conceal substance use from their providers.

Kentucky began defining neonatal abstinence syndrome, or withdrawal symptoms, as child abuse this year. The legislature added that to a foster care measure (House Bill 1). Under the new law, such a finding could result in the termination of parental rights unless the mother enrolls in a drug-addiction treatment program within 90 days of the birth.

State caseworkers who learn of babies having neonatal abstinence syndrome make recommendations to family court judges on a case-by-case basis, and removing the baby is not an automatic outcome, John Cheves of the Lexington Herald-Leader reports.

The researchers recommend improved access to prescription-drug monitoring programs, increased substance-abuse screening, use of medication-assisted therapy and substance-abuse treatment referrals.

“State-level actions are critical to curbing the opioid epidemic through programs and policies to reduce use of prescription opioids and illegal opioids including heroin and illicitly manufactured fentanyl, both of which contribute to the epidemic,” the report says.

Bowling Green hospital no longer releases information about births, in an effort to keep infants safe from possible abduction

The Medical Center at Bowling Green no longer releases information about births to the news media or through social media, following recommendations from the National Center for Missing and Exploited Children.

“This is a decision we recently made for safety reasons,” Jill Payne, executive vice president and chief nursing officer of the large hospital, told Don Sergent of the Bowling Green Daily News. “We’re always assessing and updating our practices.”

Parents who still want to announce the birth of their baby can still do so in the newspaper.

“We will still give people the opportunity to announce the births online and in print,” Joe Imel, director of media operations for the Daily News, told Sergent. “For more than 150 years we’ve listed births, deaths and anniversaries. We still want to offer the community the opportunity to announce these proud moments.”

The National Center for Missing and Exploited Children made this recommendation as an attempt to reduce the number of child abductions.

Graphic from National Center for Missing and Exploited Children; to view a larger version, click on it.

An analysis by the center, which it clearly states is not a scientific study, concluded that there have been 325 confirmed infant abductions in the U.S. since 1965, with 43 percent from health-care facilities, 42 percent from homes and 14 percent from other locations.

A map on the center's website says Kentucky has had four cases of infant abduction in that 53-year period.

The center recommends not posting a mother’s or infant’s full name where it is visible, and not using full names in announcements to the news media, Payne told Sergent. She added that the hospital is working to educate parents about this safety concern.

“We’re starting to inform folks now,” she said. “We’re making parents aware and educating them about using social media. It’s a great way to publicize these things, but sometimes it can be a dangerous place to put information.”

The Kentucky Hospital Association says it does not track such policies of the 47 Kentucky hospitals that offer maternity services. (The state has 92 acute-care hospitals.) Mike Rust, president and CEO, said KHA hasn't taken a position on the issue, and decisions are up to individual hospitals.

Bill to certify professional midwives passes Senate, but no time remains to pass it through the House by normal means

By Melissa Patrick and Al Cross
Kentucky Health News

FRANKFORT, Ky. -- A bill to give midwives professional recognition in Kentucky made it out of the Senate March 27 on a 29-8 vote, over opposition from doctors. It is all but dead, with only two days left in the legislative session, though the bill's sponsor refused to declare it so.

Sen. Tom Buford

"It's not too late, but as one might say, we are at the finish line and it will be close if it does," Sen. Tom Buford said in a telephone interview. "The General Assembly always has their barrels loaded until the last day after the veto session." Legislators' final day, Saturday, April 14, is scheduled to reconsider any legislation Gov. Matt Bevin may veto.

Since the legislature postponed its last pre-veto session day to Monday, April 2, it only has that day and the veto-override day left, and the constitution requires a bill to be read in a chamber on three separate days before passage. The House would have to add the bill's contents to a Senate bill pending in the House, pass it and return it to the Senate for final approval.

Kentucky has no rules or regulations for midwives. Buford's Senate Bill 134 would create a Certified Professional Midwife Advisory Council under the Kentucky Board of Nursing, which would be responsible for setting care standards for midwives to follow and issue permits to those who qualify.

Buford said Kentucky needs a law on midwifery "because you and I, believe it or not, we could go and be midwives tonight without any training or anything. That's a scary thought."

The Nicholasville Republican said opposition to the bill comes from the Kentucky Hospital Association and the doctors' lobby, the Kentucky Medical Association, even though he has tried to accommodate them with several changes to it. He said the groups voice safety concerns, but their opposition is more likely a "turf battle," adding that "it's usually about the money."

"Remember that a midwife might perform a home-birth delivery for free, or she might charge $3,000 to $6,000 -- and at a hospital, if everything goes right, it's $20,000 if you are in and out in two to three days with no complications," Buford said.

Mary Kathryn DeLodder, a leader of the Kentucky Home Birth Coalition, told the Senate Health and Welfare Committee March 19 that the coalition has been seeking the legislation since 2012. She said Kentucky has more than 700 home deliveries a year, and 33 states already have certified professional midwife programs.

"This bill is about increasing access to the only category of care providers who are clinically trained to attend births in the home settings, and that is the certified professional midwife," she said. She later added, "Families don't rely on Facebook groups to verify if their dentist or their pediatrician is legitimate, and they shouldn't have to do that for their midwife either. . . . Opposing this bill doesn't make anyone safer."

Buford told the Senate that his bill isn't about whether or not Kentucky will have home births, "because we are," he said. "This is a question of whether you want those home births to be safe. To be a somewhat certified individual that comes into that house, knows what they are doing."

Republican Sen. Ralph Alvarado, a Winchester physician who spoke strongly against the bill during the committee meeting, filed a floor amendment with a long list of conditions that would prohibit a certified midwife from attending a home birth, prohibit midwives from performing abortions and require them to have a transfer agreement with hospitals that deliver babies. Any violation of the law would result in a Class D felony.

Alvarado's amendment got 18 votes, all from Republicans, except Senate Democratic Leader Ray Jones of Pikeville; 19 senators, half the Senate, supported it. Democratic Sen. Perry Clark of Louisville did not vote. (See roll call here.)

Buford said afterward that if the legislation becomes law, the advisory council could add some of the same requirements in the "crushing amendment," but he would prefer to leave these decisions to the Board of Nursing and not allow "men to make the decision on how a woman will have a baby."

State not keeping up with 'explosion' of babies with hepatitis C

The dangerous liver virus hepatitis C "has skyrocketed among Kentucky births amid the state’s raging drug epidemic, but attempts to prevent, track and control the infectious, curable disease have fallen short," Laura Ungar reports for the Louisville Courier Journal. That means many kids don’t get the care they need, risking cirrhosis and liver cancer in adulthood — or even early death."

One in 56 Kentucky births in 2014-16 were to mothers with a history of the disease, Ungar reports, citing state records she obtained: "Those births more than quadrupled between 2010 and 2016, from 260 to 1,057 a year. The latest national rate, from 2014, was one in 308."

Just how many Kentucky children develop the disease is unknown, "because state records show most don’t get the necessary testing when they grow out of their moms’ immunity as toddlers," Ungar writes. "Research suggests Kentucky fares much worse than other states because drug use among young women is so widespread."

A federal study showed hepatitis C rose 213 percent in four years among women of childbearing age in Kentucky, from 275 cases to 862 per 100,000 women, Ungar reports: "That's nearly 10 times the national rise of 22 percent, from 139 to 169 per 100,000 women."

Courier Journal charts

“We have seen a dramatic increase in the number of cases of children exposed to hep C – an explosion,” said Dr. Kristina Bryant, a pediatric infectious disease specialist affiliated with Norton Children's Hospital, told Ungar, who notes, "The true scope of the problem is even bigger; more than half of people with hep C don’t know they have it."

Ungar discovered another problem: Kentucky officials aren't tracking, preventing and testing for the disease as diligently as they could.

"Staffing shortages have kept cases from this year and last — and a backlog of previous cases involving children — from even being entered into computers," she reports. "Moms and kids have often gone untested. Hep C screening isn’t mandatory. While it’s recommended for moms at high risk, doctors don’t always ask about drug use and women don’t always admit to it. Plus, babies whose moms have hep C commonly don't get follow-up testing, especially when they’re raised by someone else."

Ungar adds, "Overall efforts to curb hep C have failed." She notes Kentucky had the nation’s highest rate of acute hep-C infections in 2010-14, and "The state and federal governments spend a fraction of what advocates consider necessary to fight the disease; groups are asking for $100 million more at the federal level."

Ungar's story, which took up more than two pages in the Courier Journal's print edition, includes several case studies of families affected by the disease. It was initially published online by USA Today, for which she also works.

Neonatal Abstinence Syndrome conference to be held Nov. 10 at Northern Kentucky University; it's free, but registration is required

Northern Kentucky University is hosting a conference Nov. 10 that will convene researchers from across the Ohio River together to discuss neonatal abstinence syndrome: addicted babies.

The conference, which organizers hope will be an annual event, will be held from 9 a.m. to 4:45 p.m. in Room 107 of the NKU Student Union in Highland Heights.

The conference will focus on evidence-based research into neonatal abstinence syndrome, with the hope of increasing collaboration among NAS researchers.

Vice News chart

As part of a series of stories on opioid addiction called A Nation in Recovery, Keegan Hamilton of Vice News writes that NAS "has overwhelmed the medical system, and many intensive care units for newborns are at capacity." The rate of babies being born with NAS has increased 400 percent since 2000, with one baby born with the syndrome every 25 minutes. In Kentucky, one out of every 50 newborns has NAS.

The keynote speaker for the conference will be Judith Feinberg, a professor of behavioral medicine and psychiatry at West Virginia University, who will present "The Opioid Epidemic: A view from the Belly of the Beast."

Other topics include the state of research on NAS, and what is left to find out; what communities can do about the opioid epidemic; and opioids through the eyes of a physician.

Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic, will wrap up the day in a conversation led by NKU Provost Sue Ott Rowlands. In a visit to the campus last year, Quinones challenged the region to develop collaborative efforts to battle the opioid epidemic.

"As part of the response to that challenge, NKU has been leading the effort in working with universities to establish ORVARC,” Rowlands said in a press release.

Quinones was the keynote speaker at the most recent Foundation for a Healthy Kentucky policy forum, where he talked about the importance of re-building communities as part of the ultimate solution to the opioid epidemic.

"Heroin is the perfect symbol for how isolated we have become as Americans, and how much we have killed off or ignored what would bring us together," he said. "I believe therefore more strongly than ever that the antidote to heroin is not Naloxone, it is community."

Registration for the conference is free, but required. Click here to register. Click here for the conference schedule.