Improve Care for Babies Born Drug Dependent

Introductory Paragraph

Babies who are born with an opioid dependence experience discomfort and trauma. They can scream and cry, have tremors, struggle with eating, and can struggle with being comforted. There are opportunities to help the babies while mothers, and the often overwhelmed and hospital staff that are trying to care for the babies and mothers. New approaches based on recent evidence-based research includes moving from NICU and pharmacology treatment to a mother-centered approach with eat, sleep, console. This approach emphasizes keeping the mother-infant dyad together in a calm setting while encouraging frequent feedings, comforting, and swaddling to treat Neonatal Abstinence Syndrome (NAS).

Key Information

Since the 1970s pharmacology has been the standard for treating babies born drug dependent or with Neo-natal abstinence syndrome (NAS) with a greater severity or exposure. Physicians have utilized methadone or morphine in treatment of NAS born babies. Traditionally infants born with drug dependent have been managed in the NICU to treat due to concerns of complications. The Finnegan Score/Finnegan Tool has dictated the care level for babies born drug dependent.

Treatment of infants showing signs of withdrawal includes supportive care approach to treatment and can include creating a dark and quiet environment, swaddling the infant to improve self-stimulation, and providing frequent feedings to reduce infant stress.

Other strategies include skin-to-skin contact for comfort and promotion of the infant’s attachment to the mother/caregiver, as well as other comforting techniques such as rocking or swaying the infant. Frequent feedings address hydration level. Educating families on methods of care is also important to provide ongoing supportive care of the infant.

Breastfeeding has been proven to also be an effective approach if the mother is receiving medication-assisted treatment and has no other complications that inhibit breastfeeding.

Complications from NAS can include:

• Low birthweight
• Jaundice
• Seizures
• Sudden infant death syndrome (also called SIDS).
• Developmental delays
• Motor problems
• Behavior and learning problems
• Speech and language problems
• Sleep problems
• Ear infections
• Vision problems

Recent research has introduced a new approach to treatment of babies born drug dependent - Eat, Sleep, Console- which is a mother-center approach.

• Eat: Is the baby feeding normally?
• Sleep: Is the baby able to sleep?
• Console: Can the baby be consoled within ten minutes of crying?

The Eat, Sleep, Console approach may be used alone or in conjunction with the Finnegan's model for scoring. The simple components of the approach show a decrease in overall length of hospitalization as well as a decrease in need for a pharmacological approach.

Relevant Research

Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome

A Novel Approach to Assessing Infants With Neonatal Abstinence Syndrome

Impact of Parental Presence at Infants' Bedside on Neonatal Abstinence Syndrome

Implementing the Eat, Sleep, Console Approach for NAS Management: Review of Literature

Impactful Federal, State, and Local Policies

Substance Exposed Infants & States responses to the problem

Available Tools & Resources

Substance Exposed Infants & States Response to the Problem

Opioid-Dependent Newborns Get New Treatment: Mom Instead of Morphine

Women & Infants Clinical Institute- Guide for Eat, Sleep & Console

Webinar- NAS: The Eat, Sleep, Console Approach

Caring for Opioid-Exposed Newborns Using the Eating, Sleeping, Consoling Care Toolkit A Downloadable Guide

Care of the Newborn Exposed to Substances During Pregnancy Practice Resources for Healthcare Providers

Caring For Your Newborn At Risk For Substance Withdrawal with the Eat Sleep Console Method A handout for new parents

Safe Project Addiction and Mental Health Resources for Women

Promising Practices

Eat, Sleep, Console (ESC) Model Several hospitals are implementing the approach lead by Dr. Matthew Gossman of Yale-New Haven Children's Hospital. The following hospitals put together a ESC playbook for information and implementation.

• Bakersfield Memorial Hospital, Bakersfield, California
• CHI Franciscan, Tacoma, Washington
• Yale-New Haven Children’s Hospital

The guide includes recommendations, approaches and resources.

Programs for Volunteers to Cuddle Babies Experiencing Withdrawal

There are a growing number of programs that have volunteers come to the hospitals to cuddle the babies. This helps comfort the babies and reduces the stress on the nurses--two important benefits.

Magee-Womens Hospital "Cuddle the Crisis"

• At Magee-Womens Hospital of UPMC in Pennsylvania, volunteers are helping babies born addicted to opioids by cuddling, nurturing, and comforting the babies as they go through withdrawal.
• Cuddlers provide them with additional comfort, as opposed to having to start an IV or give a baby morphine

Add more programs here with links to learn more.

Music Therapy

Using a combination of pacifiers and music therapy, healthcare workers are able to ease the pain of babies born to mothers who used opioids during their pregnancy. If you can improve babies feeding and sleeping, decrease their crying and make them more calm, then you've just eliminated three of the major symptoms that lead babies to have to need medication or hospital stay.

Components:

• A NICU music therapist uses music and live-singing, patting and rocking to match the baby's behavior state, ultimately training the child to soothe itself
• Use of special pressurized pacifier that plays music.

The Maryland Patient Safety Center is working with 30 birthing centers to come up with standardized care for babies suffering from NAS. This standard of care is significantly reducing the length of stay for these babies.

Standards can vary from baby to baby, but should include:

• Creating a calming environment with little stimulation - quiet rooms and low lights
• Cuddle rooms where volunteers rock and soothe babies
• Can use massage and music therapy
• Some medicine (morphine or methadone)
• Treat mother's addiction and mental health in conjunction with babies' treatment

Neonatal Withdrawal Center

Lily's Place

Lily's Place is the first nonprofit infant recovery center for provides services for parents and families struggling with addiction. The center is specifically designed for babies with NAS with small, quiet, dimly-lit nursery rooms and 24-hour nursing staff. Parents are trained to help their babies via therapeutic handling techniques and they learn CPR and basic child care as well as the specifics of NAS. Contact Lily's Place (304) 523-5459 including the following:

• Legislation to support NAS centers
• Pre-opening NAS Center Operations Planning
• Funding & fundraising for a NAS center

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