The tiniest victims of the opioid crisis had no choice in their drug addiction. Between 15-20 percent of infant patients admitted to UAB's Regional Neonatal Intensive Care Unit, or NICU, are suffering through opioid withdrawals after being born to mothers who used drugs during pregnancy, according to UAB NICU staff.
These babies have neonatal abstinence syndrome, or NAS, and they require 24/7 care as they shake, clench and often cry inconsolably.
"They vomit, they have diarrhea, they even get mat burns on their elbows and knees because of their fretfulness," said UAB Neonatologist Joe Philips, M.D.
"It's really pitiful to see these babies withdraw," Philips said.
Philips explained the babies are usually born full-term and the biggest medical challenge is managing their withdrawal symptoms. NAS babies born at UAB will start out in the NICU where doctors and nurses evaluate them using a scoring system to determine whether they require methadone to treat withdrawal symptoms. The methadone is administered to the babies in their bottles, the dose gradually tapered down as withdrawal symptoms decrease.
UAB NICU nurse. (Source: UAB)
"The baby is born addicted and not treating the baby is dangerous," explained Philips. "It's rarely fatal, but they can have seizures and they're absolutely miserable."
Once the baby is stabilized, they can move one floor down to the continuing care nursery, which has private rooms where parents can stay with their baby and participate in their care. Some babies can be weaned off the methadone in 10 days, but Philips said they've had some babies that have stayed for several months. Each case is different and every baby is treated with individual care.
The newborns' exposure to drugs in utero also varies. Some mothers used heroin during pregnancy, others took a replacement therapy like Subutex under a doctor's care. Dr. Philips pointed out that many of the mothers of NAS babies had legitimate prescriptions for opioid painkillers.
"It's very complicated and it's easy to judge, but there for the grace of God go I," said Philips.
"These substances are highly addictive. It would be nice if there was a federal and state directive to curb this terrible epidemic because these babies are completely innocent and suffering terribly."
"It's easy to judge, but there for the grace of God go I. These substances are highly addictive."
- UAB Neonatologist Joe Philips, MD
Sandra Milstead, RN, has worked in UAB's NICU and continuing care nursery for 27 years. She said encountering addicted newborns was unusual when she first started her career. Now she and the rest of the nursing staff work with these babies daily, trying to help educate families on how to provide comfort and care.
"I think it's very important for moms that have NAS babies to be able to be with their baby as much as possible," said Milstead. "I think that is, a lot of times, the driving force for them to get on a better pathway with their life."
This can be challenging given the complex family dynamics that often accompany the birth of an NAS baby. Alabama's Department of Human Resources (DHR) determines who the baby goes home with, but while the infant is under their care, UAB staff helps facilitate support for families and encourages bonding with the baby, even if it's for a limited time.
"We want them to be involved in the care, to understand what their baby is going through," said Amanda Lewis, RN. "The mom feels a lot of guilt for the symptoms that the baby is experiencing, so we don't judge them. They need love and taking care of just like the babies do."
Amanda Lewis, RN (left) and Sandra Milstead, RN (right)
The continuing care nursery is equipped with mechanical swings and private rooms that feature soft lighting. On the day we visited, the floor was quiet, but that's not always the case. NAS babies often have a high pitched cry and their irritability can be stressful for new parents. Milstead and Lewis both teach new parents soothing techniques, like swaddling and rocking, which can be effective at calming down an anxious and crying baby.
UAB has one of the largest NICUs in the country. Between the intensive care unit and the step down continuing care nursery, they can accommodate 118 babies and the unit stays full. Philips said the increase in NAS babies in the last five years has caused a significant burden on the healthcare system with significant costs.
This mirrors the national story. A federal study by the National Institute on Drug Abuse found a baby suffering from opioid withdrawals is born every 25 minutes in the United States, five times the amount born in 2000. The longer hospital stay and extra care for NAS babies costs an average of $66,000, compared to $3,500 for a baby without NAS, according to the study.
As opioid addiction has increased, care for NAS babies has evolved. Milstead and Lewis said along with less judgement toward the mothers, there is a greater understanding of addiction as a disease. Milstead said she believes the families of NAS babies need more community support.
"These moms love their babies just as much as you and I love our babies," said Milstead. "Not only does the mom suffer, not only does the baby suffer, but everyone around her, her entire family. This is not just a one person disease, it is an entire family, which in turn is our entire community. It's affecting all of us."
WBRC is partnering with the FBI and the city of Birmingham for a free community event on the opioid crisis, November 13 from 6:30- 9 p.m. at the Boutwell Auditorium. The event will include a documentary screening followed by a panel discussion. Follow this link to register for the event.
Copyright 2017 WBRC. All rights reserved.