‘Heartbreaking’ to see babies suffering from opioid withdrawal
Hospital care not ‘complicated,’ but it’s hard on the staff and addicted moms caring for them
WATERLOO REGION — In 2016 there were 27 babies born at Grand River Hospital who’d been exposed to opioid use while in the womb.
“We don’t have all our numbers for 2017 yet, but we think it’s certainly in that neighbourhood, if not higher still,” said Dr. Bruno DiGravio, head of pediatrics.
It’s a small number when compared to the more than 4,000 babies born annually at the hospital, which has the busiest childbirth centre in the region. But in-hospital treatment for newborns with neonatal abstinence syndrome — babies born exposed to addictive drugs — can run between three to six weeks.
If a newborn shows signs of opioid withdrawal, hospital staff typically treat the baby in the neonatal intensive care unit (NICU) using a small dose of morphine administered every four to six hours. The severity of withdrawal is closely monitored using a scoring system called an Abstinence Scale. This process can take weeks.
“It’s not complicated care, but it’s hard on the staff for sure,” said DiGravio, who has been a pediatrician in the region since 1990. “To see babies suffering from withdrawal symptoms is a heartbreaking thing for anyone to see.
“They become very jittery or tremulous, they have poor feeding, they develop diarrhea, they have these high-pitched shrieky cries; they’re in pain,” said DiGravio. “It’s a very serious disorder.”
In most of the cases DiGravio encounters, the moms are recovering from addiction and on a medically supervised methadone program. This opioid drug prevents the symptoms of withdrawal and does not give the patient a feeling of being high.
“For those mothers that are on methadone ... they should not stop their methadone suddenly without medical supervision during pregnancy,” he said, adding that withdrawal or relapse could threaten the pregnancy.
DiGravio said it’s important to make a distinction between new moms using methadone to recover and those who are using drugs illicitly. In the latter cases, there are a whole host of additional risks to mother and baby.
“It does exist in our town, but it’s not the majority of our cases,” said DiGravio. “The majority of our cases are methadone.”
If they can, moms being treated with methadone are encouraged to breastfeed as it can help the babies with withdrawal.
“A little trace of methadone that might be in the breast milk is fine and we actually encourage mothers to breastfeed those babies,” he said.
New developments in care are being researched.
In January, the Canadian Paediatric Society released new recommendations to doctors and hospitals to help them take better care of mothers and babies, as the number of babies born exposed to opioids is climbing.
According to the Canadian Institute for Health Information, in 2016-2017 about 1,850 newborns in Canada were exposed to addictive drugs; a large percentage of them involved opioids. The number marks a 27 per cent increase from 2012-2013.
The Canadian Paediatric Society says the best way to treat mom and baby is to keep them together in hospital if possible, rather than sending the baby to the neonatal intensive care unit.
“Keeping mothers and their infants together has been shown to lower NICU admissions, promote breastfeeding, shorten hospital stays and decrease the need for prescription drugs, Dr. Thierry Lacaze, chair of the CPS fetus and newborn committee, said in a news release.
DiGravio said the hospital tries to keep mom and baby together when possible, but the hospital doesn’t have the space for them both in the NICU.
“Sometimes we can move a mother and baby pair to the pediatrics floor, then the mother can remain with the baby and be part of the baby’s care,” he said. “Those babies do go home sooner; we think it’s a healthier thing to maintain the bond between mother and baby.”