Healing the Smallest Victims of the Opioid Epidemic
Some of the babies in the neonatal intensive care unit (NICU) at Einstein Medical Center Philadelphia were just born early. Some have medical issues, like respiratory problems. But recently, as more and more mothers have become addicted to opioids, many of their children are born with the same harrowing addiction.
Opioid dependence among newborns, says NICU nurse manager Maryann Malloy, has become a significant problem throughout Philadelphia. “Even one baby is too many,” she says, “but at any one point in time we could have two to four of those babies going through that particular withdrawal process.”
Withdrawal is incredibly difficult for adults, but for infants it is particularly traumatic.
Take for example, the average healthy infant. A well baby is capable of self-soothing. Fingers in the mouth, breast feeding, bottle feeding … all of these activities can calm most infants. Not so for those who are withdrawing from opiates.
“The kids, when you look at them when they’re just lying there, frequently they’re having tremors. So some of the stuff you can do that’s non-pharmacologic is just really swaddling them up nice and tightly and keeping them in a dark atmosphere,” says neonatologist David L. Schutzman, MD, director of neonatology at Einstein Medical Center Philadelphia and Clinical Associate Professor of Pediatrics.
“They require a lot of love,” adds Malloy. “They can be inconsolable. A well baby, when changed or fed or cuddled, has the ability to feel safe. They can get themselves together even if they’re going through a rough spot. In these babies, that mechanism has been compromised by the opiates.”
Because of that, Malloy says, it takes them a much longer time to get to the point where they can be comforted and soothed.
Adults going through withdrawal have the ability to express what they’re going through, she adds. “They can tell you, ‘I’m too hot, I’m too cold, I’m thirsty, I’m hungry.’ Infants don’t have the ability to tell us those things. We are going based on subjective observations, which really does make it as much of an art as a science caring for them.”
Opioid-dependent babies suffer through what seems like a living nightmare for weeks on end. These infants need to be weaned from their involuntary drug addiction, typically through the use of morphine and phenobarbital, says Dr. Schutzman. The precise treatment often depends on what the mother was taking.
“If moms are pretty much dependent on opiates, whether it’s methadone, Subutex or what have you, we treat the babies with morphine,” he explains. “If moms are on other drugs besides opiates, or a lot of other drugs and opiates, we usually start with phenobarbital.”
Morphine and phenobarbital are used in ever decreasing amounts to gradually wean the baby from their opioid dependence. That process can take four to six weeks, he adds.
Dr. Schutzman is sometimes asked: Why don’t you just let opioid-addicted infants go cold turkey? Wouldn’t that accelerate the process?
“People say, ‘They’re not going to remember it, anyway.’ The answer to that is, one, the kids are just so disorganized, they’re not going to eat well and they can get dehydrated and have other problems,” he says. “Or, two, they can seize. Neither of which is very good.”
One approach to soothing these babies is through the use of volunteers called cuddlers, who are brought into the neonatal intensive care unit to rock, comfort and feed babies—and not just opioid-addicted babies, but many others who reside in the NICU.
“Certainly, having the cuddlers who hold them, walk with them—that kind of assistance is very helpful,” Dr. Schutzman says.