By Sandy Hemphill, Contributing Writer, BabyMed
In 2010 and 2011, three hospitals in Florida treated 242 infants with neonatal abstinence syndrome (NAS), a cluster of symptoms that occur when babies are born dependent to the opioid and other painkillers their mothers took during pregnancy. These babies require intensive care as they withdraw from these addictive drugs and most of them spend their first weeks in neonatal intensive care units (NICUs). Two new studies, however, suggest these babies fare better and can go home sooner if they are allowed to room-in with their mothers.
Of the babies in the Florida study:
- 99.6% were dependent to opioids at birth,
- 97% required NICU stays, and
- 26 days was the average length of NICU hospitalization.
Typical neonatal symptoms of opioid dependence include tremors, seizures, extreme irritability, difficulty sleeping and feeding, vomiting, and diarrhea. Some NAS babies experience long-term physical and mental deficits and, in some cases, NAS is fatal.
Rooming-In Shortens Hospital Time
A 2015 study from Queen’s University in Kingston, Ontario, Canada, found the need for fewer medications and shorter time in the hospital for NAS babies who were allowed to share a room with their mothers instead of staying alone in the NICU:
- Pharmacotherapy dropped from 83.3% to 14.3%.
- Hospital stay shortened from an average of 25 days to 8.
The mothers of these babies were taking prescription and/or illegally acquired opioid painkillers, heroin, or methadone. Use of these substances is on the rise in the US as well as Canada. In the US, as many as 22% of pregnant women are estimated to take one or more of these drugs during pregnancy. Between 2000 and 2009, the US rate for NAS rose from 1.2 per 1,000 births to 3.39.
The More Mom Time, the Healthier the Baby
Researchers at Boston Medical Center (BMC) evaluated the neonatal care of 39 mothers and babies with NAS:
- 49% (18 mothers) used buprenorphine (opioid painkiller) during pregnancy.
- 46% (17) used methadone.
- 5% (2) used short-acting opioids.
All babies were born at 37 weeks or later gestational age. Babies were given an assessment of dependence (Finnegan score) every four hours. One element included in the score was if the mother was in the room during assessment or not. Another factor was breastfeeding.
The mean rate of parental presence during Finnegan scoring was 58%. The more often the mother was in the room during the baby’s evaluation, the less time mother and baby spent in the hospital and the fewer medical interventions the baby needed.
Breastfeeding and Bonding
The only other factor that strongly influenced treatment options and hospital stay was breastfeeding. In both studies, the more the baby was breastfed, the better it was able to overcome its dependence. This response is thought to be a result of the high nutritional value of mother’s milk but it is likely the influence of frequent and prolonged skin-to-skin contact, too. The close contact required of breastfeeding is thought to have comforted troubled babies and helped them bond with their mothers. One long-term effect of NAS is difficulty bonding between mother and child.
Sources:
"CDC Report: Infant And Maternal Characteristics In Neonatal Abstinence Syndrome."CityMatch. CityMatCH.org, 9 Mar. 2015. Web. 5 May 2016.
Newman, Adam, et al. "Rooming-in care for infants of opioid-dependent mothers."PMC. Canadian Family Physician / The college of Family Physicians of Canada, Dec. US National Library of Medicine / National Institutes of Health. Web. 5 May 2016.
"Parents' presence at bedside found to decrease neonatal abstinence syndrome severity."EurekAlert! American Academy of Pediatrics / American Association for the Advancement of Science, 30 Apr. 2016. Web. 5 May 2016.