Posted: March 22, 2017 at 4:21 am
By Ashley Rogers, Rachel Solis, and Mostafa Hashem
Nationally, between three and five babies per every 1,000 babies suffers from neonatal abstinence syndrome. In West Virginia, that number is 33.
Neonatal abstinence syndrome or NAS occurs 48 to 72 hours after birth and may occur when pregnant women take certain drugs during their pregnancy. The drugs pass through the placenta and if used close to birth, the baby may be dependent and come out with withdrawal.
Symptoms affect a baby’s neurologic system and include but are not limited to trembling, skin breakdowns, seizures, irritability, bad eating habits, sleeping problems, and gastrointestinal issues.
“They tend to be tight,” said Dr. Mark Cody Smith, a neonatologist at WVU Medicine. “So, when you lift them up their head doesn’t lag back as much because they have extra muscle tone from the withdrawal.”
WVU Medicine’s Children’s Hospital aims to prevent and treat NAS. Since 2013, doctors and nurses have used a Modified Finnegan Score to treat babies with NAS. The system uses a table to rate a baby’s symptoms to guide doctors and nurses in the right course of treatment.
“We have a neonatal abstinence syndrome committee. We formally train all the children’s hospital nurses how to do this score very specifically and accurately. We created a standard algorithm and once a baby reaches a certain score we would start medication.”
Doctors monitor babies for at least five days. From there, the first step is to keep the baby and mother together as much as possible. Next, they teach the parents general newborn care and how to control the environment around the baby while going through withdrawal.
“Right now, in the NICU, we have five in treatment and at any given time there are three to five babies that are in that five-day window being watched,” said Courtney Sweet, a neonatal clinical pharmacy specialist at WVU Medicine.
In cases where medicine is needed, treatment may last up to 18 days depending on the type of drugs the baby was exposed to, the amount, and how long the baby was exposed.
“Our average is 18 days and we hope to have everybody off or nearly off before they reach a month of life. Occasionally a baby has to stay longer than that but we like to get them home and out of the hospital environment,” said Sweet.
Doctors want the public to know that these affected babies are born dependent and not addicted because with addiction comes the behavior to seek drugs. And while they are at a higher risk, just because babies are exposed doesn’t necessarily mean that they will grow up to have problems with addiction.
“Dependence is when you have introduced the substance for so long and so consistently to your body that your physiology expects that and that has become your body’s new normal so when you do not have that substance or that medication your body will miss that,” said Ty Reidenbaugh, a resident at WVU Medicine.
“Addiction is when you’re feeling a number of things so frequently to such a severity, that it begins to disrupt the course of your day and the course of your life.”
Some hospitals run programs that provide “baby cuddling” services for newborns in order to help comfort them during the withdraw. Trained volunteers go into the NICU and spend time holding and cuddling them. The care and comfort that these volunteers provide help to soothe babies with a human touch.
“Hearing your heartbeat is beneficial to them,” said Grace Hatala, a volunteer baby cuddler at Ruby Memorial Hospital.
She says that the biggest noticeable behavioral difference between these babies and healthy ones is their constant shaking. “When they’re shaking I always rub their arms.”
The biggest physical difference is how small they are, some even less than five pounds. The smallest and most affected babies are put into an incubator and are unable to be cuddled. In these cases, “you can still stick your arms through just for the human touch and warmth,” she said.
Many of the volunteers at Ruby Memorial Hospital are nursing students. The hospital has eight two-hour shifts per day, ranging from four to six a.m. to nine to eleven p.m.
Despite the early morning shifts that volunteers could potentially be given; the volunteer position is becoming popular among students and other volunteers. “We actually have a waiting list,” said volunteer coordinator Nancy Beckner.
In terms of prevention, doctors urge mothers to talk to their providers about the medicines they are taking during their pregnancy so that the baby can be properly monitored. When a pregnant woman is abusing a drug, doctors work to help the mother get treatment before birth. Doctors hope to start treatment early enough to slowly wean the mother and baby off of any drugs or medicines.
“You don’t want them to stop cold turkey during pregnancy. It can put the baby and the mom at risk of having bad outcomes and going through withdrawals,” said Smith.
West Virginia state law says all babies that are exposed are reported to child services so that they have an active list of who should be on their radar.
“It puts a big burden on the CPS to look into all of these cases,” said Smith. “As a whole, we’re kind of in a region that’s been hit hard.”
About 70 percent of babies go home with their biological mothers, the other 30 percent typically go to another family member if possible. However, Sweet says they hope to get all babies home with their biological mom for the sake of the mother and the infant.
“For the mom, if we can get her treatment, then having a baby and having that baby go home with her is a really big predictor of her long-term success and her long-term recovery.”