Local hospitals seeing increase in opioid-dependent newborns

May 21, 2016 12:00 am • Last Updated: May 22, 2016 7:24 pm

Maternal-child nurse Deborah DeConto has worked with many young, single mothers after unplanned pregnancies, helping them learn to care for their babies, gain confidence and build support networks.

Of her recent cases, one she worked with this winter stands out as one of the many examples of how deeply the opioid crisis is affecting southeastern Connecticut.

As prescription opioid and heroin addiction have permeated all facets of the community, from inner cities to middle-class suburbs to wealthy enclaves, from senior citizens to middle-aged adults and youth, even the very youngest have not been spared.

“I met this mom after her baby came home from the hospital,” DeConto said Thursday at the Waterford offices of the Visiting Nurse Association of Southeastern Connecticut. “The baby had been addicted to methadone.”

The little boy’s mother became pregnant while addicted to heroin.

Her obstetrician prescribed methadone for the duration of her pregnancy, an opioid replacement medication that helps addicts quit illegal drug use, and is considered a safe option for both the mother and the developing fetus to avoid the harsh and potentially harmful withdrawal symptoms.

In the uterus, the baby developed tolerance for regular doses of opioids, first from the heroin the mother was using, then from methadone.

Once he was born and the umbilical chord cut, though, his would-be opioid supply abruptly would be cut off. Withdrawal symptoms would be sure to follow.

After the boy was born at Lawrence + Memorial Hospital in New London — one of eight opioid-dependent newborns there since Jan. 1 — the nurses and doctors knew he’d be with them for awhile.

Instead of the average newborn hospital stay of two days, this baby would be in L+M’s Neonatal Intensive Care Unit for two weeks or more as he was weaned off opioid dependence — first with morphine and then phenobarbital, the standard treatment for the increasingly prevalent condition called neonatal abstinence syndrome.

“These babies are very irritable, crying a lot as if they’re in pain,” said Dr. Edward James, medical director for the NICU.

He said the unit sees about 40 to 50 babies a year with this condition.

“They’re hyper-responsive, they shake a lot, their sleep is poor, they have growth problems, difficultly feeding, diarrhea, sweating,” he added.

In short, said Katie Van Dyke, nurse manager of the NICU and pediatric unit at L+M, “their symptoms mimic what adults go through in withdrawal. It impairs their ability to be a baby, to eat, sleep and start to grow.”

Nationwide, the numbers of newborns with neonatal abstinence syndrome grew fivefold from 2000 to 2012, when there were 21,732 babies with this condition, according to the National Institute on Drug Abuse, a federal agency that is part of the National Institutes of Health.

The most recent research shows that, as of 2013, the rate was about 27 opioid-dependent babies per 1,000 born, said Sharon Amatti, public health adviser for the Center for Substance Abuse Treatment.

Given the worsening of the opioid crisis since 2013, hospitals are likely to continue seeing more of these babies, she said.

“We’re getting more and more requests for basic technical assistance and training from hospitals” in how to care for these babies, Amatti said. “We’re trying to be more proactive, and develop a plan for hospitals to deal with these families.”

The Substance Abuse and Mental Health Services Administration, which is part of the federal Department of Health and Human Services, recommends hospitals include using medication-assisted treatment for mothers and babies, and bringing social service, medical and child welfare resources together “so everyone is talking to each other and agreeing on plans for the mother and baby,” she said.

Like its counterparts nationwide, The William W. Backus Hospital in Norwich also has been caring for more opioid-dependent newborns.

Sarah Bouchard, nurse-manager of the Backus Birthing Center, said the hospital saw 11 of these babies in 2014, then 20 in 2015, and the upward trend appears to be continuing this year.

Since January, Backus has had eight babies with neonatal abstinence syndrome, Bouchard said.

“We’ve got three in the hospital right now,” she said earlier this month. “Most of the time, by the time moms come to us for delivery, they’ve been on methadone or Subutex,” another opioid replacement medication.

“These babies require more nursing care, and we do a lot of teaching with the parents,” Bouchard said. “These babies need decreased stimuli, low lights, low sound, lots of skin-to-skin contact. And we recommend breast-feeding.”

Visit from DCF

As at L+M, each of the mothers also is visited by a social worker, Bouchard said, and the state Department of Children and Families also is contacted.

A DCF worker visits the mother and baby in the hospital as soon as possible and meets with the hospital nurses, doctors, social workers and others on the “treatment team,” said Kristina Stevens, administrator for the agency.

While about a third of these babies ultimately ends up in foster care, she said, DCF tries to avoid that.

“We ask all the family members to come to the table and develop a plan for how the child can stay in the home, or stay with relatives,” she said.

According to NIDA, the average hospital stay for each opioid-dependent baby is 17 days, at an average total cost of $66,700 — most of it paid by Medicaid.

That compares to about $3,500 for the average two-day stay for a normal newborn.

But there are ways to take better care of the growing number of these babies at lower cost, said Hendree Jones, a professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill who researches pregnancy and drug use.

Her research, done in conjunction with colleagues at Yale Medical School in New Haven, has found that the babies of addicted mothers prescribed Subutex — a cousin of the more widely known anti-addiction drug Suboxone that is considered safer for pregnant women — do better than those whose mothers were prescribed methadone.

The Subutex babies need less medication to counteract withdrawal symptoms and can spend fewer days in the hospital — an average of 10 versus the national average of 17, Jones said.

Her research also found that greater use of “nonpharmacological interventions,” including having nurses work closely with the mothers in the hospital to teach them to care for their babies, also enables them to go home sooner.

“When the mothers and babies are in the room together, we can cut the medication in half,” said Jones, who is executive director of UNC’s Horizons Program, which treats drug-addicted mothers-to-be.

“We teach the mothers to swaddle the babies, keep the lights low, help them understand the babies’ cues and work on breast-feeding” — considered one of the most important strategies, she said.

Also essential, Jones said, is helping the mother establish a healthy home after the baby leaves the hospital.

That can involve a period of home nursing care, connecting her with parent support groups, stable housing, therapy and spiritual resources, and having her create a “safety plan” for what she will do if she relapses.

Up to two years of services is recommended.

“For many of these women, their addiction did not happen overnight,” Jones said. “But the thing that matters most in the post-natal environment for the baby is making sure the mom is as healthy and stable as possible. It doesn’t have to doom their life.”

She added that some states have responded to the growing numbers of opioid-dependent infants by seeking legal punishment for the mothers.

“It’s misguided,” she said. “That’s not going to help resolve this issue, but will only make it worse.”

Keeping mothers and babies together

At both Backus and L+M, many of the approaches advocated by Jones are being used.

While the mothers are usually released a couple of days after the birth, for example, they are encouraged to spend as much time as possible at the hospital with their baby until the child is ready to be released.

That can’t happen, Dr. James said, until the morphine treatments have tapered to zero and only phenobarbital is needed.

“We try to keep the mother and baby together as long as possible,” including letting the mother stay overnight, said Van Dyke, the L+M NICU nurse manager. “We have mothers here from eight to 24 hours a day.”

At the hospital, the mother isn’t just a bystander, but provides the care herself under the guidance of nurses, Dr. James said.

“Keeping these mothers and babies together has been one of the goals,” he said.

NICU staff also refer the mothers to visiting nurses, parenting classes and other resources they can turn to after they take their baby home, oftentimes a critical lifeline of support.

“These are very difficult babies,” Van Dyke said, “and you’re talking about mothers who already have issues with coping skills.”

Once the newborn gets through the difficult withdrawal process, research shows, their long-term health prognosis is good, although there is greater likelihood of learning disabilities and motor development delays.

But with compassionate care provided both in the hospital and after release by visiting nurses like DeConto and others, the effects of opioid dependence can be lessened for baby and mother both, she and other experts believe.

“You have to go in completely nonjudgmentally, because you don’t know why she became addicted,” she said. “And every mom whose baby is born addicted has a lot of guilt. I try to be a resource and establish a trusting relationship.”

Sometimes, she said, when her term of twice-weekly home visits ends, she’s not sure the family is ready.

But by the time she concluded her most recent case, the little boy was gaining weight and sleeping well, and his mother had learned how to provide comfort and better handle her own frustrations.

DeConto had been visiting them at Mothers Retreat Rehabilitation Center in Groton.

“This kiddo I followed for a month, twice a week,” she said. “He had a fairly nice transition after he was off phenobarbital. He did pretty well."

"Sometimes, when you let go, you worry," she said. "But sometimes, you feel like, ‘this mom’s going to do great.’”

j.benson@theday.com