Sunday, July 16, 2017

Flood of opioid-addicted babies prompts UK, other hospitals to try a new strategy of keeping them with their mothers in the hospital

Jay'la Cy'anne Clay was transferred from Richmond to the
University of Kentucky hospital. (NYT photo by Ty Wright) 
A flood of opioid-addicted babies in Kentucky and other states have prompted doctors and hospitals to rethink their strategy of sending the newborns to specialty hospitals that their mothers often have difficulty visiting, Catherine Saint Louis of The New York Times reports from Madison County. She begins with the harsh reality for one baby:

"Convulsions rocked her tiny body as she lay under warming lights in the nursery of the Baptist Health Richmond hospital. She vomited and made strange, high-pitched cries. The infant was going through opioid withdrawal. For more than a decade, her mother, Jamie Clay, 28, had been hooked on oxycodone. For six months now, she had been in a recovery program, taking another opioid that eased her addiction but put her baby at risk for withdrawal."

Fifteen of every 1,000 Kentucky babies are addicted to opioids, and those "with the worst withdrawal symptoms are routinely separated from their mothers and whisked by ambulance, at great expense, to hospitals hours away, filling up beds intended for newborns who have even more serious problems, like heart defects, Saint Louis reports.

"Urban medical centers nationwide are scrambling to expand neonatal intensive care units or to build separate facilities to accommodate a tide of opioid-exposed babies arriving from rural communities. The result, many experts say, is an exercise in good intentions gone awry. After their babies are moved, many new mothers, poor and still struggling with addiction, cannot find transportation or the resources to visit."

But babies need their mothers. "Separating newborns in withdrawal can slow the infants’ recovery, studies show, and undermine an already fragile parenting relationship. When mothers are close at hand, infants in withdrawal require less medication and fewer costly days in intensive care," Saint Louis reports.

"The standard treatment is to drip tiny doses of morphine into the mouth with a syringe to make the newborn comfortable enough to eat and sleep. Then, over two to 12 weeks, the infant is weaned off morphine. But community hospitals in rural areas rarely have neonatal intensive care units in which staff can administer morphine. So, after a brief period of observation, infants in withdrawal are transferred to more sophisticated facilities. . . . Increasingly, experts fear that babies are being removed from mothers they need so they can get morphine they do not. Now some researchers are urging hospitals to pursue a new strategy."

One alternative is "rooming in," in which mothers and babies stay together, not in the neonatal intensive care unit, which typically has bright lights and noise. "A baby in withdrawal needs a quiet and dark environment without too many stimuli," Saint Louis writes. "Rooming in" and similar strategies have reduced the average length of hospital stays and, even more, costs.

At UK's Kentucky Children's Hospital, “When we keep babies and mothers together the entire time, we almost never have to treat” with drugs, and infants who don't need medication stay four or five days, while babies who do stay 22 or 23 days,neonatologist Dr. Lori A. Shook, told Saint Louis.

"Soon, a unit with eight private rooms for babies with neonatal abstinence syndrome and their mothers will open," Saint Louis reports. "The infants will be kept out of intensive care and with their parents."

Children's Hospital has a "Kentucky Kids Crew" that "picks up babies in severe withdrawal from 20 hospitals in rural towns across Southern and Eastern Kentucky," Saint Louis notes. "In 2015 and 2016, this unit was over capacity almost half the time. Nearly 60 babies in withdrawal had to be diverted to other hospitals, because there were infants with even more pressing needs, like life support or breathing assistance."

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