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Health team aids those addicted in the womb

The American - 6/29/2017

Every 25 minutes, a baby is born in the United States suffering from opiate withdrawal, according to the National Institutes of Health.

At Norman'sHealthPlex, a special team works to relieve the suffering of babies affected by Neonatal Abstinence Syndrome - the medical term for symptoms related to infant drug withdrawal.

"They have difficulty sleeping and eating. They're very restless, and they're very irritated, and they're sometimes not tolerating formula if they're formula fed," said Neonatal Intensive Care Unit nurse Anne Wingfield. "They're inconsolable."

In the womb, babies absorb the drugs their mothers ingest, whether illicit or prescription. When a baby is born, the source of the drug is eliminated, propelling infants into various degrees of withdrawal, depending on the substance and the level of exposure.

Opiates aren't the only drugs that affect babies, though they are one of the most common, said Becky Farley, Norman Regional Health System social work case manager.

"About 10 percent of our newborns are exposed to some substance," Farley said.

Even drugs used to wean addicts from heroine, like suboxone and methadone, create severe withdrawal for infants, Farley said.

"We deliver about 2,800 babies a year, so 10 percent that have been exposed are about 280 a year," said Susie Graves, director, NRHS Women's and Children's Services. "I've tried to spread awareness with the administration about the scope of this problem. This is not just a problem for Oklahoma."

Still, based on 2012 data, Oklahoma ranks second nationally for rates of substance abuse, according to the Oklahoma Department of Mental Health and Substance Abuse Services.

Babies with NAS are fussy and need more attention than most infants, while their mothers may not have the skills to deal with a needy baby, Farley said. Without intervention, there is a high risk of infant abuse, such as shaken baby syndrome.

"We've been working very hard with our OB physicians to combat the problem prior to delivery," Farley said. "I get a consult, typically when a mom's in labor, and I assess the need for intervention."

The HealthPlex team works to keep the mother and baby together. Mothers that bond with their child and are more informed are less likely to abuse their children, Farley said.

In 2012, newborns with NAS stayed in the hospital for an average of 16.9 days compared to 2.1 days for those without NAS, according to National Institutes for Health, and hospital costs for newborns with NAS were $66,700 on average compared to $3,500 for those without NAS.

"Being in an NICU (neonatal intensive care unit) is a cost," said Kathy Milam, Acute NICU manager. "That's much more expensive than being in a newborn nursery or a mother-baby unit. These babies have longterm stays. Some are born early."

To promote early identification, Norman Regional provides special education from the EMSStat paramedics to the nurses who care for the newborns to hospital staff, Graves said.

"It takes someone from all of these departments to make sure we're identifying the babies we can help," said Graves, who oversees a multidisciplinary team.

NAS symptoms: Babies with NAS symptoms are tested using the Modified Finnegan Neonatal Abstinence Score.

"When we get the babies from the nursery, their abstinence scores are usually pretty high," Wingfield said. "We have a scoring system for babies that we suspect will be withdrawing from the mother's medications. They stay in the nursery, for the most part, but if their scores become very high, they come to the NICU for care."

Health care professionals rate tremors, hyperactivity, high-pitched crying, jerks, skin abrasions, sweating, nasal stuffiness, sneezing, poor feeding, excessive sucking, vomiting, loose stools and more to determine if a baby is suffering from NAS and to what degree.

"We have to provide them with a quiet environment," Wingfield said. "We swaddle them, and we sometimes change their formula. If their scores become high enough, we start medication."

Wingfield has been pivotal in helping develop the care needed for these special babies.

"I've been a NICU nurse for 21 years, and I had the pleasure of taking care of a baby that was withdrawing and I became very attached to her," Wingfield said. "I'm friends with her adoptive parents on Facebook. She was with us almost two months. She taught me a lot."

That experience moved Wingfield to work with administrators to improve the intervention and treatment.

"I started looking at what we needed to help these babies go through this withdrawal process," Wingfield said.

NAS babies need more frequent diaper changes, formula changes to aid digestion and need to be held or rocked to facilitate sleep.

"It's difficult to see these babies go through the withdrawal process and dealing with the mom and helping her to get healthy herself and get treatment," said Milam.

Full-term babies often stay longer than pre-term because the drug exposure was longer, and they have more fat cells that have absorbed the drugs, she said.

"About a year ago, I think we had three at one time, very irritable babies," Milam said. "We enlisted our volunteers to hold these babies and provide comfort when the parents aren't able to be there."

Nurse manager Mari Newcomer said identification is key.

"We're able to identify by maternal history when the mom comes in, so we're better able to prepare and initiate the scoring and observation," Newcomer said. "Symptoms can begin at eight hours or they can begin several days later. We've had re-admission of newborns where the emergency room or the pediatrician's office have identified these symptoms on a visit."

No judgment, just help: The length of stay in acute care is shorter if babies can stay with their mothers.

"They all come to mother-baby and our goal is to keep mom and baby together," said registered nurse Tonya Faires, who supervises the nursery and the mother-baby unit. "When they're identified, we begin assessing and scoring for withdrawal symptoms."

Most of the time, mothers and babies can stay together, she said, and the mothers help with the identification of NAS symptoms.

"We spend time working with the moms, explaining things for them to watch for," Faires said. "They're a big part of the assessment. We see each baby respond differently. The first things we'll see are digestive issues. Spitting up formula or breast milk and not tolerating feedings."

The baby's skin often breaks down, especially on their bottoms, which the moms can see doing diaper changes.

"We really try to involve the moms as much as possible," Faires said. "Research shows the babies do better, the more contact they have with their moms. Not all moms are well enough to care for the baby, so that's when we notify Becky [Farley] to get involved."

Farley connects mothers with resources and acts as a liaison with pediatricians. She also educates adoptive and foster parents for the challenges ahead with these babies when mothers chooses to relinquish them.