Many newborns facing opioid withdrawal

ON THE SECOND FLOOR of the Tufts New England Medical Center is a room with no light and no sound but for the high-pitched screams of babies.

Nurse Christine Lavoie tends here to the tiny patients, who are sweating, easily startled, breathing frantically, and difficult to feed. Their muscles are extremely tense. “You feel like you’re breaking their legs when you’re changing their diapers,” Lavoie said.

This is the neonatal intensive care unit, and it’s filled with newborns going through withdrawal from the opioids to which their mothers are addicted. “Nothing makes them happy,” Lavoie said. “They are terrible eaters. They constantly cry. It’s heart-wrenching.”

It’s also a largely unnoticed consequence of the opioid addiction epidemic. The number of babies born opioid dependent in Massachusetts hit 1,197 in 2015, up 29 percent since 2011, according to the state Department of Public Health. That’s a faster rate of increase than the national average. The incidence in babies of opioid exposure has grown in Massachusetts from 13.2 for every 1,000 live births to 17.2, the figures show.

New England has the second-highest proportion of babies born exposed to opioids—called neonatal abstinence syndrome—after the east-south-central region of the country.

“It is an actual crisis,” said Leslie Kerzner, a neonatalist at Massachusetts General Hospital. And Michael Kelleher, director of special projects at the health department, said it’s getting worse.

Babies of opioid-addicted mothers are about three times more likely as other babies to be born prematurely. Nineteen percent will have a low birthweight and 31 percent will suffer respiratory problems. New research shows their vision also may be weakened.

“When you cut the cord, the baby now experiences sudden withdrawal of that drug,” said Kerzner, who both studies and treats the problem.

They’ll stay in the hospital two to three weeks, compared to two to three days for a healthy baby, and caring for them will cost up to 27 times as much, or $93,400.

Yet the state’s response to this is plagued by a lack of centralized information, limited sharing of what information does exist, inadequate access to birth control for opioid-addicted parents, and insufficient training for providers, a five-month study by the health department and attorney general’s office found.

The study also found inconsistencies in screening, access to effective treatment, and support for mothers and their babies.

Hospitals “did not know a whole lot” about how to treat this problem when it started to surge, said Faye Weir, director of parent child services at South Shore Hospital.

Now, rather than treating opioid-exposed babies in the neonatal intensive-care unit, or NICU, Weir said, her hospital has trained its pediatric nurses to take care of them in the conventional pediatric ward.

This leaves room in intensive care for babies who need to be there, and saves money. The average stay for an opioid-exposed newborn at South Shore Hospital has declined over the last four years from 31 days to 16 days, Weir said.

“Pediatrics is a much better place for them to be kept but not all hospitals are doing this,” she said. “The mothers have the opportunity to hold their babies and spend time with them when they are on the pediatric floor rather than NICU.”

Centers that treat people for addiction also increasingly allow opioid-addicted mothers to go back and forth to the hospital to care for their newborns, said Julia Reddy, perinatal substance abuse systems coordinator at the Institute for Health and Recovery. Hospitals are “beginning to see mom as treatment” for the baby, Reddy said.

“That’s because staying with the mother is better for the baby,” Weir said.

But there has to be a balance, said Weir and other experts. Some mothers, still contending with their own addictions, aren’t prepared to care for children. The mother who is, said Weir, needs time to “take breaks and have room for her own recovery.”

Even before that point, she said, the system isn’t particularly well prepared to deal with opioid-addicted expectant mothers. “There are not a lot of options for pregnant women as far as addiction counseling,” Weir said.

South Shore also has a “cuddler” program in which volunteers comfort the babies. So many people have volunteered that there’s a waiting list, Weir said.

At Tufts, treatment of the opioid-exposed newborns includes keeping them in a dark room and bundling them tightly in Velcro swaddlers. Massachusetts General Hospital adds white noise machines, vibrating seats, and baby massages to soothe them.

These methods don’t always work, Kerzner said. In the worst cases, she said, they’re actually given opioids. “The only thing to give back to them is the opioid, neonatal morphine or methadone, giving just enough to the baby to settle the baby’s symptoms,” she said.

Last year, about 30 opioid-exposed babies at MGH went into withdrawal, Kerzner said.

Lavoie, the nurse in the neonatal intensive-care unit at Tufts, said there is a need for more public awareness of the problem.

“Unless a family member is addicted to drugs or they are in the healthcare profession,” she said, “a lot of people don’t know how big of an epidemic this is.”