Asher George Aldrich-Galvin’s first days were fierce.
“He couldn’t relax. His arms and legs would just be rigid and he would scream — that was the worst part,” says his mom Jessica Aldrich, 29, of Clermont, New Hampshire. “That was when he was feeling the most pain.” His persistent high-pitched entreaties punctuated his most difficult days and hours at the Children’s Hospital at Dartmouth-Hitchcock in Lebanon, New Hampshire, after his birth in January. “He screamed so much and so hard that he lost his voice,” Aldrich recalls.
Mom was prepared, though — if still unsettled — for the opioid withdrawal symptoms her son would experience. Aldrich first became addicted to prescription painkillers at the age of 16, when, she says, she began using the readily available drugs to cope with mental, physical and emotional abuse. “I knew that what I was doing was not good for my baby [or] for me. But I knew that going cold turkey was not an option,” she says. So beginning about 12 weeks into her pregnancy, Aldrich entered a drug treatment program at Dartmouth-Hitchcock for expectant and post-partum moms. Through the program, she received maintenance medication to address her addiction to prescription opioids and education from clinicians on what to expect — including withdrawal symptoms her baby might experience and ways to address them — and support from other participating mothers in the program’s group counseling sessions.
In the throes of an opioid abuse epidemic, involving prescription painkillers and heroin, an increasing number of newborns in the U.S. are going through withdrawal, experiencing what’s called neonatal abstinence syndrome.
Nationally, the rate of babies born with NAS, which can result from the use of opiates during pregnancy, increased five-fold from 2000 to 2012. Twenty-seven in every 1,000 babies were admitted to neonatal intensive care units suffering from NAS in 2013, compared with 7 in every 1,000 in 2004, according to a study published in the New England Journal of Medicine last year. Many other babies not admitted to the NICU, like Asher, also suffer from symptoms of withdrawal.
[See: The 5 Latest Poison Control Threats Kids Face.]
In Asher’s case — despite a harrowing arrival into the world — his symptoms were still decidedly less severe than what many babies with NAS experience. Similar to what adults go through, opioid withdrawal symptoms for babies can include everything from gastrointestinal upset — vomiting and diarrhea — to respiratory symptoms, such as runny nose and sneezing, to itchiness that leads them to scratch themselves, as well as having trouble sleeping, says Dr. Alison Volpe Holmes, a pediatric hospitalist at the Children’s Hospital at Dartmouth-Hitchcock.
NAS can also lead to difficulties feeding, weight loss, irritability and increased muscle tone. “They’re more rigid — we call it hypertonicity or hypertonic, so the resting tone of the muscle is increased,” says Dr. Kimberly Spence, a neonatologist at SSM Health Cardinal Glennon Children’s Hospital in St. Louis, and an associate professor of pediatrics at St. Louis University School of Medicine. This can impair babies’ ability to move and make their backs, arms and legs unusually stiff, as Asher’s limbs were, sticking straight out, shortly after he was born. Research suggests about 3 to 10 percent of babies with NAS experience tremors, Spence notes; she thinks it’s probably closer to 3 percent. She adds that NAS symptoms frequently persist for months.
But early invention can help quell symptoms, so experts say its critical that parents and other caretakers be educated about what to expect and how to help babies perservere.
The Children’s Hospital at Dartmouth-Hitchcock recently completed a three-year project, begun in 2013, conducted by an interdisciplinary quality improvement team seeking to better care for infants with NAS. This included moving babies who had been exposed to opioids in utero out of the NICU to room with parents, as appropriate, in the pediatric ward. It focused on increasing family participation in their care and prenatal education, like touting the importance of skin-to-skin contact with babies. The results of the research project were published in May in the journal Pediatrics.
“Traditionally babies with risk for withdrawal or risk for withdrawal symptoms were managed in neonatal intensive care units, where it’s frequently not possible for the families to stay with and take care of their babies,” says Holmes, who led the research. “We knew that if babies and families were together, and that the babies were able to feed on demand and have a quiet, dark, non-stimulating environment, that that would actually help to control their symptoms.” That was in addition to encouraging other measures like breast-feeding and feeding on demand to soothe the baby.
[See: How to Cope With Gestational Diabetes.]
The results: Among other benefits, the new care model led to decreased use of medications to address withdrawal symptoms in opioid-exposed babies and shortened hospital stays for those treated with medications — where drops of morphine are given to some infants to ease withdrawal — decreasing the average length of a hospital stay from 17 to 12 days. Where 46 percent of babies at risk for NAS had been treated with morphine, that rate dropped to 27 percent, and since the project wrapped up, it’s decreased further to 20 percent, Holmes says.
When and whether governmental agencies intervene in cases of maternal substance abuse varies. But experts say moms enrolled in drug treatment programs, who follow protocol, are typically able to care for their children from the first days. Taking only prescribed maintenance medications, like methadone, and other approved medications may help ensure a mother can safely breast-feed her baby as well. “There are some restrictions for nursing — such as HIV and its associated conditions, or polysubstance abuse, but moms who are maintained on methadone or buprenorphine and have been clean are eligible to nurse,” Spence says. Like Holmes, she extolled the benefits of such non-drug interventions to help babies going through withdrawal.
Aldrich and Asher’s dad, Josh Galvin, traded off holding Asher during long days, so Asher could be soothed by skin-to-skin contract. “He spent most of his time either on my chest or on Josh’s chest. When I became overwhelmed we switched off, and that worked really well,” Aldrich says. “The whole point was to keep him as calm and as comfortable as possible.”
Experts emphasize the importance of expectant moms struggling with opioid abuse getting the care they and their baby need — despite the reluctance some may have to disclose the issue. “I think the best thing to do is to seek prenatal care and … to be managed with either buprenorphine or methadone, and to continue to be in rehab afterwards,” Spence says. In her experience, she adds, infants of expectant mothers whose opioid withdrawal is managed with buprenorphine seem to have less withdrawal and don’t need to be treated as often with morphine as infants exposed in utero to methadone, though the latter is still considered the gold standard in addiction treatment during pregnancy.
Either way, experts say, it’s critical not to go it alone or quit cold turkey. “You are supposed to get on a maintenance medication, so that you don’t go through periodic withdrawal — because withdrawal is what’s dangerous to the pregnancy and the baby,” Holmes says. “Those two medications don’t get into the breastmilk in high levels at all.” By contrast, she adds, commonly abused prescription painkillers, such as oxycodone and Oxycontin, as well as heroin, get into human milk at higher levels.
Providers also stress the importance of regular follow-up care. Aldrich continues to go to group counseling biweekly and take maintenance medication. Highly motivated to quit, she has been clean for a year — since the first stirrings of her son.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
“I was scared that it wasn’t going to work, because I had never tried to quit before. This was my first attempt, ” she recalls. “There were times that I had serious, serious cravings, but I would feel him moving.” Though at first she says the guilt was overwhelming — knowing what Asher would have to go through as a result of her addiction — she was encouraged by a nurse and other moms to turn her attention to what she could do for him going forward to lessen his symptoms of withdrawal, which subsided shortly after he got home. He’s now 6 months and doing well, she says. “He is amazing. He’s such a happy boy.”
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Helping Babies Overcome Opioid Withdrawal originally appeared on usnews.com
