How to Save Babies from the Opioid Scourge

By Khadaroo, Stacy Teicher | The Christian Science Monitor, March 13, 2016 | Go to article overview

How to Save Babies from the Opioid Scourge


Khadaroo, Stacy Teicher, The Christian Science Monitor


You wouldn't know it by looking at the peaceful infant in pink ruffles, but when this baby girl was born, her cries and shakes from drug withdrawal were so strong she had to be transferred from a smaller hospital to the intensive care nursery at Dartmouth- Hitchcock Medical Center.

As soon as they could, the staff here shifted her to a private room in the pediatrics ward, where her grandmother Diana - her full- time guardian - has been staying for two weeks, soothing her with tight embraces, lavender baths, and dolphin music. "I do my prayer book with her. I sing to her. I read books to her. I do rocking in the chair.... It works big time," she says.

Drug withdrawal symptoms are not typically so severe. But the number of babies at risk for the short-term condition has risen dramatically at the hospital in recent years because of the prescription-opioid and heroin epidemic. Last year, nearly 1 in 10 babies here had been exposed to opioids before birth, up from 1 in 20 just a few years back.

Around the United States, communities have been struggling to craft policies to deal with what has become one of the most pressing issues facing society - the misuse of painkillers, which in turn leads some people to start taking heroin. Their efforts range from advocating tougher law enforcement to educating doctors to putting limits on the amount of painkillers that can be prescribed to patients. Exacerbating the problem is the discouraging reality that only about 20 percent of those who struggled with illicit drug use in 2014 received treatment, a government survey found.

While the effect of the crisis on adults is daunting enough - heroin-related overdoses have nearly quadrupled in the past decade - it becomes particularly heart-rending when it reaches into the nation's hospital nurseries. In 2012, experts estimated that about one baby was born every 25 minutes in the US with what is known as neonatal abstinence syndrome (NAS) - symptoms stemming from a mother's opiate use. That amounted to about 22,000 infants a year, more than five times what it was in 2000.

But rather than be overwhelmed by the problem, the staff at Dartmouth-Hitchcock embraced a new way of thinking about how to treat the babies - enlisting their caregivers as central partners. They've had stunning results, and now they're being looked to as a model.

- - -

In early 2013, doctors here were diagnosing nearly half the babies that had been exposed to opioids as having NAS and needing morphine in the intensive care nursery.

But Dartmouth pediatrics professor Alison Holmes had a hunch. More than that, she had research from Europe and Canada showing that for many of the babies, the less they were medicated and the more they stayed skin-to-skin close to their mother or a primary caregiver, the better they would do.

Step 1 in the quality improvement project she launched was talking with the mothers and their families. "I knew a lot about ... medication treatment. I did not know that much about how to work with a family that was struggling through addiction and recovery," Dr. Holmes says.

It turned out that the way the staff "scored" babies - using a numerical system to measure their NAS symptoms - wasn't working as well as it could. A rigid schedule, checking for symptoms every two to four hours, meant interrupting parents' sleep and sometimes scoring a baby who could be tired or crying because of hunger instead of drug dependency.

High scores made it more likely they'd end up in intensive care, where parents couldn't stay with them and give them the familiar contact they needed.

"The infants do better with care in a calm, dark environment - where they are fed on demand and held a lot - than in an open intensive care unit where there are monitors and beeps and ... a very medical culture ... that tends to want to treat crying babies with medication," Holmes says.

The staff modified procedures so that babies would be scored just after feedings. …

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