COLUMBUS, 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.
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.