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OLUMBUS, Ohio — Baby M arrived in our neonatal intensive care unit the other day. Barely 24 hours old, she was clearly in pain. Her high-pitched cry pierced the unit again and again, her tiny legs twitched uncontrollably, and she couldn’t sleep. It’s difficult to comfort her — no amount of swaddling, holding, rocking, soft humming, offering her a pacifier, or other strategies soothe her.

Like the multitude of other babies in this NICU at Nationwide Children’s Hospital, Baby M was born dependent on drugs that her mother took while pregnant. It’s likely Baby M is in withdrawal from heroin or OxyContin, but we won’t really know for certain until we can talk with her mother and see her test results.

Twenty years ago, we rarely encountered babies with what is today known as neonatal abstinence syndrome in Central Ohio. Now it is so common that we will soon have an entire NICU devoted to caring for babies with it. A new report from the Centers for Disease Control and Prevention estimates that about 24,000 drug-dependent babies were born in 2013, the last year for which there are complete statistics. That’s one baby every 20 minutes.

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Mothers who take drugs during pregnancy give birth to babies who are physically dependent on those same drugs. When the umbilical cord is cut at birth, the baby immediately starts to go “cold turkey.” Withdrawal from heroin or other opioid — from any addictive drug, for that matter — is hard on the body. It is heartbreaking to watch these innocent newborns struggle.

Some babies are as rigid as boards. Many jerk or twitch constantly, rub their bodies against blankets and get the equivalent of rug burn, cry for long periods, have trouble feeding, vomit after feeding, or have loose stools. Some have serious trouble breathing or go into convulsions.

The sooner treatment can begin, the better. The best thing for a drug-dependent baby is for its mother to spend time in the NICU holding and cuddling her child, especially using “kangaroo care.” This skin-to-skin, chest-to-chest way of holding a baby has been shown to help premature infants thrive and seems to help comfort babies with neonatal abstinence syndrome as well. Breastfeeding is also invaluable, both because it promotes mother-child bonding and because it gives the baby essential nourishment, antibodies, and other nutrients.

Many drug-dependent babies need more than this. We generally follow guidelines from the American Academy of Pediatrics. They recommend giving the baby the same class of the drug he or she encountered before birth, then gradually reducing the amount day by day. Morphine and methadone are the two most commonly used medications for managing the symptoms of withdrawal.

Weaning babies off drugs takes time. It depends on so many factors — how long the mother had been using drugs, her daily dose, whether she was using multiple drugs, and whether she smoked or drank a lot of caffeine. The average stay in our NICU for babies with neonatal abstinence syndrome is 17 days, but that hides a large range. Some babies stay for eight weeks or even longer.

Although our work in the NICU is focused on the babies in our care, we pay close attention to the mothers as well. Our team includes doctors, nurses, nurse social workers, pharmacists, nutritionists, psychologists, chaplains, specially trained volunteers, and physical, occupational, massage, and music therapists. At the end of the day, though, the most important part of the care team is the person who will take the baby home. So we do everything possible to make each mother feel welcome and valued and to help her understand how important she is in her baby’s development. Many mothers respond well to this nurturing.

Interacting with mothers who continue to use drugs or who don’t seem to grasp the gravity of neonatal abstinence syndrome can be a challenge. Anyone working in this field must come to terms with the fact that they can’t control what happens outside the NICU, or what happens when a baby goes home. If we have concerns that the child may be facing an unhealthy or unsafe situation, of course, we will report that to children’s services.

We hope and pray for an end to the opioid epidemic and what it does to thousands of newborns each year. Until then, we and other providers will take care of the mothers and their babies as best we can.

Gail Bagwell is an advanced practice RN and clinical nurse specialist for perinatal outreach and Amy Thomas is an RN and NICU administrative clinical leader at Nationwide Children’s Hospital in Columbus, Ohio.

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  • Imagine being that child who is being drugged several times a day for nine months. How horrifying to think that any given day that child could lose some kind of function for the rest of their lives. After the mother and her dealers turn her unborn child into a experiment, it is usually handed right back to her. This seems like Germany during WWII. but a least if they survived they were freed from the abusers, not returned for 18 years!!!

  • I am a NICU nurse in a small Canadian city. Overall, I have seen far too many NAS babies born. I was moved by this article particularly because of the comment about how nurses working in this field have to come to terms with the fact they can only control what happens in the NICU and not what happens once the babies go home. This is very difficult for me personally and I struggle day to day with that reality. I feel these babies need a strong advocate voice to speak on their behalf outside the hospital. Unfortunately, I don’t believe they have that… Addiction is a beast for sure, one in which moms and the community need to take by the horns. One in which there also needs to be onus for… and that part I feel is missing. It becomes “the man in the mirror” song all over again.

    • I think that my nieces new baby may be having withdrawl. He was born this past Monday July 3rd-and still isn’t home. He was full term but only 4 lbs 9 oz, and 17 inches-she also smoked. She is saying they are keeping him because he isn’t eating enough-but I know her family’s history-she is my brothers daughter, and they are heroin addicts. I want to help, but privacy keeps me from knowing exactly why he is there. I held him about 8 hours after he was born and he was so tiny and just slept, but I know the signs may not have shown up just then. Thank you to the nurses who care. I want to be an advocate for this baby-it’s breaking my heart.

  • I am a Nursery nurse in a rural hospital and we see far too many babies who have been exposed to drugs in utero. The whole community suffers when these babies suffer because it effects a whole family system and everyone involved with the care of this baby. Many moms deny they have a drug problem until the baby begins to have problems and tests positive for multiple drugs. Drugs are s strain on the health care system as well as the care givers. We need more specialized units to care for these babies as well as the moms. Thank you for your article.

  • I’m prescribed Xanax and my baby was born feb 26. He showed moderate withdrawals but NICU put him on phenobarbital then after two days lowered the dose. There are so many different Drs that they are not keeping track of his progress ending up with four great straight days then one day of irritability and they give him a loading dose. Now they are trying to put him on Ativan after 18 days without benzo. I’m nervous because they already admitted they don’t know too much and do not involve me with any decisions. I don’t know what to do

  • With having a morning after pill and other easy access to birth control makes me wonder if a drug addict mother would go for late term abortion to avoid jail time.

  • Hello my name is tom hoag , I live in ks city ks after praying about it I feel god is leading me to volunteer in the new born area I am 63 and our kids are having kids. I feel so much love for her, I would like to just donate my time in this area. if you could help me at all I would love it. thank you in advace Tom Hoag

  • Install NOISE CANCELLING speakers around the cradle and problem is solved. Treat her like any other babies. Rock her as usual and stop doing so after at which time a normal baby would fall asleep. The problem is apparent only when one choose to entertain it. If one choose to PROCEED as business as usual, the problem would not exist. Just treat them as normal babies with all expectations of a normal BABY.

    • Anonymous, do you have experience with addicted babies? This is not a ‘normal’ baby. The baby is suffering from withdrawal and is in great pain. It would be considered neglect to leave the child as one would a ‘normal’ baby. This newborn does not have to mental capacity to have the manipulative thought process of ‘if I cry, I will get attention.’ With this being said, the problem is apparent and it does exist to any person that has a brain. I hope you don’t ever have to care for a child on your own.

  • So very sad. I am concerned however about the breastfeeding aspect. What if a mother is still using? I’m guessing if a mother used drugs while pregnant breastfeeding certainly isn’t going to stop her. It seems to me the time would be better spend on things that actually matter so that the mother is prepared to take the baby hom.

  • Well written. Thanks for sharing. Had no idea the statistics were so high for babies born addicted. I pray for them and for their mothers. Nurses who work with these high risk babies need to be commended for their dedication and hard work in bringing comfort to the little ones and to their moms. God bless all nurses.

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