Every 15 minutes, somewhere in the United States, a baby is born suffering opioid withdrawal.

In 2016, 741 babies born in Virginia were diagnosed with Neonatal Abstinence Syndrome, showing symptoms such as irritability, tremors and seizures caused by withdrawal from addictive substances used by the mother while pregnant.

In 2017, the Virginia NAS rate rose to 819. Of those, 295 were born in Southwest Virginia. Carilion Roanoke Memorial Hospital treats, on average, three babies with NAS per week.

For the past eight years, babies in the Roanoke and surrounding areas were treated for NAS through an outpatient clinic that followed them weekly to monitor methadone treatment – or the babies were treated at Carilion’s Neonatal Intensive Care Unit. However, the clinic was at capacity and NICU was so full there were not enough beds for non-NAS babies, such as preemies.

Enter the new transitional nursery, which opened in September.

In its infancy, the transitional nursery has already treated 68 babies with NAS.

According to Dr. Jacinda Hays, neonatal physician at Carilion Roanoke Memorial, approximately one-third of those babies have been from Franklin County.

The nursery

“We wanted to approach treating NAS differently,” Hays said. “We didn’t feel like being on methadone for months was good for a baby’s developing brain. At the same time, Yale came out with a new model of care called ‘Eat, Sleep, Console,’ which put a huge emphasis on all the environmental and non-pharmacological things we can do to prevent or lessen withdrawal for babies.”

The Eat, Sleep, Console model of treatment for NAS babies measures whether the infants are eating and sleeping, and whether they are consolable. The formerly used Finnegan’s scoring tool has a list of 23 criteria for assessing NAS symptoms.

“We realized these babies didn’t need to be in the Neonatal ICU — they didn’t need that high level of care,” Hays said. “What they need is quiet, dark and they need their mom.”

Next to its main nursery, Carilion had a second nursery that was being used for supply and equipment storage. Officials were able to make small modifications to that nursery to create a low-stimulation environment by placing the lights on a dimmer switch and installing special acoustic tiles to keep sound out.

The focus is on keeping the room dark and quiet and on limiting visitors. Hays said they also keep the babies swaddled, and teach mom how to rock and sing to her baby as well as promote breastfeeding for moms who are in treatment and not using. She added that new moms on Subutex or methadone can breastfeed.

The transitional nursery has seen a decrease in treatment time for NAS babies. The average treatment time was three months with methadone. With the Eat, Sleep, Console model, infants are usually discharged within a week and do not use methadone. Occasionally, a baby will be treated with a dose of morphine to soothe his or her pain, but Hays said that is the exception not the rule.

Hays said only one baby has had to leave the transitional nursery and be taken to NICU in the five months the nursery has been open. She said more hospitals are looking to follow Roanoke’s lead in starting a transitional nursery.

Involving moms

Hays said that over the years, physicians have also seen changes in infant care that led them to offer greater support and resources for recovering mothers. More and more moms were trying to get clean and remain off substances while trying to handle an infant in withdrawal.

“It wasn’t a very safe combination,” Hays said.

Hays added creating a less judgmental environment was key to making moms comfortable.

Dr. Kimberly Simcox, Obstetrics and Gynecology at Carilion, said she addresses addiction issues and concerns during a mother’s first visit. She supports the American College of Obstetrics and Gynecology opinion that seeking obstetrical care should not expose a woman suffering from substance use disorders to criminal or civil penalties.

“Addiction is not a moral failing,” Simcox said. “Extensive research has shown that addiction is a chronic, relapsing disease with genetic components. Management for addiction should parallel that of other chronic diseases, such as diabetes or hypertension. We do not criminalize a diabetic patient for not taking insulin.”

If a mom is not able to care for her baby, or needs assistance with substance use disorder, hospital workers strive to plug them into various resources for help.

“The moms make all the difference,” Hays said. “We have great staff, who love to hold, swaddle and rock these babies but the mom is who baby knows. The mom’s heartbeat, smell, voice, is what baby has known in utero and that is what is most comforting to them after they are born.

“All of these moms want to help their babies, even the moms who are high as a kite,” Hays said.

Simcox said, “I encourage my patients to meet with social workers and care coordinators who specialize in assisting pregnant patients with substance use disorders. These individuals are phenomenal advocates for my patients. They help my patients prepare for motherhood during recovery, navigate the complexity of community resources, and interact with protective agencies and law enforcement.”

Simcox said she discusses what to expect at the time of delivery regarding social and child protective services, and what is considered “reportable.”

“I reassure them that seeking help and striving towards recovery is the most effective thing that they can do for themselves and their babies,” Simcox said.

Prenatal care

For a woman who has been using opioids and finds herself unexpectedly pregnant, Simcox said the first step is talking with a doctor.

“I encourage all women who struggle with substance use disorders to tell their providers,” Simcox said. “We have programs in the area that can provide the help that they need. Tapering off opioid medications, or detoxing, is generally not recommended during pregnancy. There are no standardized protocols, and withdrawal as well as overdose can be harmful to both the mother and fetus.”

In Roanoke, there are a few providers who will treat pregnant women with Subutex or methadone. If a mother who is suffering from substance use disorder delivers in Roanoke the newborn is kept at the hospital for a minimum of five days to monitor for withdrawal. As long as mom is able to legally care for her child physically, the mom is kept in a room with the baby until discharge, Hays said.

If a woman is treated with Suboxone while pregnant, the infant can still experience withdrawal, though Hays added it isn’t has severe as heroin withdrawal.

Simcox explained that in general, treating addiction is better for the developing fetus.

“Untreated addiction can be associated with preterm birth and low birth weight. Repeated cycles of withdrawal can stress the developing fetus,” she said. “Medication-assisted therapy during pregnancy is the use of long-acting medications, such as buprenorphine or methadone, to prevent withdrawal and minimize cravings. At the same time, the medication stabilizes the intrauterine environment and allows for improved delivery outcomes.”

There are buprenorphine-waivered providers and medication-assisted treatment programs in the region. Obstetricians can help guide women to these resources and online organizations such as Substance Abuse and Mental Health Services Administration can also provide more information about addiction resources.

For pregnant women with opioid use disorder in the area, Carilion Women’s Office-Based Opioid Treatment (OBOT) program is also available. The program helps pregnant women with opioid use disorder with couples and/or family therapy plus other medical treatment. The program focuses on helping women through pregnancy and those first months after delivery. When the time comes to transition care, providers work to find appropriate OBOT programs for continuing treatment.

For more information call 266-6464.

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