New treatment protocol for babies with physical drug dependence
When walking into the Haslam Family Neonatal Intensive Care Unit (NICU) at Children’s Hospital, there is a noticeable difference from the rest of the hospital. A serene, quiet environment is most often present in this area of the hospital, with nurses and parents caring for the many babies that come into the NICU for a variety of reasons.
Occasionally, high-pitched crying, tremors, seizures, hyperactive reflexes and inconsolability disrupt the peaceful NICU environment. Babies with these symptoms are most likely suffering from the horrifying withdrawal process experienced by a baby born with a physical dependence on a drug used by their mother during pregnancy. These symptoms are a result of Neonatal Abstinence Syndrome (NAS), which is the term used to describe the health issues these babies experience after they are born.
In the past year alone, the Children’s Hospital NICU has seen over 100 infants admitted because of physical dependence on a drug (600-650 infants are treated in the NICU in a year), and the neonatal team has cared for many other babies in the nurseries at Fort Sanders Regional Medical Center and Parkwest Medical Center whose symptoms were not severe enough to warrant NICU admission.
Dr. John Buchheit, neonatologist at Children’s Hospital, says most of the doctors and nurses caring for babies with NAS believe this problem has become epidemic in East Tennessee. Tennessee now consistently ranks No. 2 in the nation in per capita use of hydrocodone, with methadone usage also increasing. These statistics show the number of babies born with a physical dependence on narcotics is on the rise.
The most common form of drug dependence seen in the Children’s Hospital NICU is opioids, a class of drugs commonly prescribed for pain management. Babies become dependent on opioids and other drugs their mothers use during pregnancy because the drugs cross the placenta, therefore going from the mother’s circulation to the baby’s. When infants are born with a drug dependence, they are at a higher risk for learning and behavioral problems when they reach school age.
Because of this problem, the Children’s Hospital NICU staff has recently implemented a new, multifaceted treatment protocol that involves several disciplines throughout the hospital. Physicians, neonatal nurse practitioners, bedside nurses, social workers, a case manager, the rehabilitation team, and a pharmacist joined together to develop this approach that involves evaluating neonates with NAS by using the Finnegan Scoring System (which analyzes a range of central nervous system, metabolic, gastrointestinal and respiratory symptoms). The resulting scores allow the NICU staff to adjust treatment as needed. Any baby with scores consistently greater than 10 usually requires medical treatment.
The next important step is to get the initial symptoms of withdrawal under control by non-pharmacological measures (in other words, without medication) including keeping the babies swaddled in a quiet, dark area of the NICU and avoiding over-stimulation. Consistent feeding times are also used to soothe addicted infants. If the withdrawal symptoms are severe enough, doctors and nurses will administer appropriate medications and dosages based on the severity of the symptoms. The final goal of the protocol is weaning the baby off the medications as it becomes less dependent on a drug. The most effective treatment medication found to date for drug-dependent babies is oral morphine.
The NICU staff has developed an educational brochure about the dangers associated with taking drugs during pregnancy. Representatives from the NICU are also available to speak to community organizations and parent group about the dangers of drug use during pregnancy. To access these important resources, contact Sheri Smith, Children's Hospital Nursing Director for Critical Care Services, at (865) 541-8534.