Friday, January 29, 2016

Babies born addicted: Extremely painful way to start life

By C.J. JORGENSON for Reid Health

Her pregnancy inspired Grace to overcome addiction.
An underweight newborn lies swaddled in the arms of a nurse. Even though the blanket is warm, the little boy seizes and shakes. He’s dripping with sweat, and there’s nothing the nurse can do to ease his terrified cries. At only two days old, he’s suffering from heroin withdrawal- and is one of a growing number of affected infants, according to the community organization Heroin is Here.

These infants are the unfortunate victims of an increase in heroin and opiate use in the Richmond community. “The reality is we’re seeing this all over the country,” says Craig Kinyon, CEO of Reid Health, of the increasing heroin trend. And unfortunately, meaningful change is going to be a challenge. “It’s a long, drawn-out issue, requiring a long-term commitment.” Awareness of the issue is key, which is why Reid Health has developed a committee on heroin and Neonatal Abstinence Syndrome (NAS), the clinical term for a baby’s withdrawal, to put these babies front-and-center.

A baby’s life shouldn’t begin with detox
Defenseless and battling a monster they don’t understand, these infants have an especially challenging start in life. When a pregnant mother consumes drugs, they pass through her placenta and enter the baby’s system.

Like the mother, the baby becomes dependent on the drug. Lisa Suttle, Director of Reid Health’s Psychiatric Service Line, recently interviewed Grace, a new mother who was undergoing methadone treatment during her pregnancy. “There were times I didn’t care whether I lived or died,” Grace says of her heroin addiction, “I felt so lost.” One day, a snowstorm prevented her from leaving to buy heroin, and that’s the day she decided she wanted to change.

She found information about a methadone treatment facility and began treatment. Grace was afraid about what methadone was doing to her baby, and asked other mothers undergoing treatment if their babies had been born healthy.

Methadone treatment was a challenging time for her -- the combination of methadone and pregnancy meant she was always sick. She also said in the same breath that it made her stronger. Grace is one of the fortunate individuals able to commit to their personal addiction treatment plan, but other mothers are not as successful: “Even the patients who are motivated to get clean,” says Reid Health’s Dr. Erika Brandenstein, “most typically fall off [their addiction treatment plans] when they leave the hospital.”

Grace has been free from heroin addiction for two years. Grace’s daughter was born 11 months ago. “When she was born, you know the first time I saw her, I thought, I would do anything for her. It is hard to understand that feeling.” Because when the baby stops receiving the drug after birth, withdrawal begins.

Each baby’s detox symptoms are different and can range from excessive crying, fever, and poor feeding, to seizures, vomiting and rapid breathing. NAS is a scary and painful experience for the baby. “Infants with NAS experience pain,” says Reid Health Pediatrician Dr. Loretta Ryan, "evidenced by excessive crying and difficulty in being soothed.” As withdrawal set in, Grace’s little girl suffered tremors, cried inconsolably, and required a feeding tube. It was a painful time for Grace, too: “It was really hard to watch her go through it.”

Time is the only thing that can help these babies -- time for the drugs to leave their bodies and withdrawal symptoms to end. Some medical interventions can ease detox symptoms, but only if the syndrome is identified before mother and baby leave the hospital. However, withdrawal symptoms may not begin until 48 hours after birth, when most babies are being discharged from the hospital. Without treatment, babies suffering from NAS will struggle to gain weight, or may end up in the emergency room after experiencing severe symptoms like tremors or seizures.

These issues can become very severe, according to Dr. Ryan. “Short term prognosis is generally good if NAS is recognized and appropriate treatment is provided. Untreated NAS can lead to death from repeated seizures or dehydration from poor feeding,” she says, “I know of one baby several years ago that presented to the ER with seizures.”

After a baby is diagnosed with NAS, treatment can begin to ease withdrawal symptoms. A care team will carefully watch the baby and provide treatments like swaddling to calm fussiness, supporting weight gain with higher-calorie formula, or treating dehydration with an IV. In extreme cases, the baby will receive methadone or morphine to ease the transition. Babies suffering from heroin addiction need time to heal and overcome withdrawal, which can last up to six months.

The average hospital stay for a baby suffering from NAS is 16 to 20 days, compared to three days for typical post-birth care. Dr. Ryan says the child is likely to continue to encounter issues well into their childhood, including significant behavior problems, impulsivity and learning disorders. “Very few women who use drugs intend to get pregnant. I wish that any woman of child-bearing age who is using heroin or other street drugs had the opportunity to be on long-term birth control to prevent pregnancy. No mother wants her newborn to suffer withdrawal or to have long-term problems from the devastating effect of drugs on the developing brain.”

Awareness and action in our community
As of December 2015, Reid Health identified 54 babies born addicted to an opioid. By comparison, 31 babies were born addicted in all of 2014. Sadly, this increase in the number of affected babies is related to an increase in heroin activity in Richmond, Wayne County, and the surrounding areas. Reid Health is leading initiatives to bring awareness to both issues -- the increase in opioid use, and the increase in babies born addicted.

The Heroin is Here group, started in Fall 2014, regularly meets to share progress on awareness goals and identify intervention resolutions. The group hopes to bring awareness and change into the Richmond community through collaboration, communication, and education. A meeting in October included more elected officials, reflecting growing concern about the issue.

Reid Heath has assembled a NAS-focused committee in response to the alarming increase in the number of addicted babies. The group is charged with identifying key initiatives to lead change, such as education, prevention and treatments. Collaboration is key to effectively communicating and educating in our community, so the group is comprised of both Reid Health physicians and employees, Richmond Treatment Center, community mental health centers, independent practitioners, the Department of Child Services, law enforcement and court officers. All are working together to provide options and solutions to this crisis.

“It takes partnership,” to drive meaningful change, according to Kay Cartwright, Reid Health Vice President. The NAS committee is focused on how addiction impacts mothers and babies in our community, and will work cooperatively with local organizations like the Department of Child Services and the Richmond Treatment Center, to combat the prevalence of NAS.

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