Doctors Grapple With How Best To Treat Opioid-Dependent Newborns
When Victoria Worden of Kansas City was pregnant with her fourth child, she was addicted to heroin and hated herself for it.
“When you are in withdrawal, you feel your baby that’s in withdrawal too,” Worden says. “You feel your baby uncomfortable inside of you, and you know that. And then you use and then the baby’s not, and that’s a really awful, vulgar thought, but it’s true. That’s how it is. It’s terrible.
In her third trimester, she started treatment using methadone, and when her daughter, Lili, was born, the newborn was started on morphine to help ease her withdrawal and symptoms such as clenched muscles and high-pitched screaming.
Worden was allowed to hold, feed and care for her daughter at the hospital during those first few difficult weeks.
About 2 percent of infants are estimated to be born drug dependent, and in areas gripped by the opioid crisis, that number is even higher.
And as health experts grapple with the problem, they’re increasingly encouraging hospitals to adopt the low-tech but relatively new treatment approach that Worden was offered.
High-tech or low-tech?
Kansas City neonatologist Dr. Jodi Jackson, who treats newborns with critical health problem in the neonatal intensive care unit of Children’s Mercy Hospital, says that a NICU brimming with high-tech beeping medical monitors is not where newborns like Lili belong.
“What happened 10, 15 years ago is babies exposed were immediately removed from the mom, and they were put in an ICU warmer with bright lights with nobody holding them,” Jackson says. “Of course, they are going to be upset about that! And so the risk of withdrawal is much higher.”
Jackson has worked for years to address infant mortality in Kansas and now heads a statewide project of the Kansas Perinatal Quality Collaborative to get hospitals to use evidence-based treatment methods for neonatal abstinence syndrome. Those include keeping mothers and infants together in the hospital and providing recovery drugs when needed to reduce withdrawal symptoms.
In many parts of the state, Jackson says she’s starting from scratch.
“Many hospitals have no standard of practice, no standard approach,” Jackson says.
But improving outcomes for opioid-dependent babies will probably take more than just educating hospital staff.
Dr. Elisha Wachman, who teaches pediatrics at Boston University, says providing this kind of care is a big adjustment for many hospitals.
“It really depends on the capacity of the hospital and where they have room to house the babies for monitoring,” Wachman says. “Some of them don’t have room for the mothers to stay with the babies.”
And it’s still not clear what approaches work best.
Methadone v. morphine
For example, new research suggests that methadone may be a better recovery drug for newborns than morphine, which Wachman says is most often used. But doctors are still unsure about methadone’s long-term effects on infants.
“There’s very few high-quality clinical trials that have been done in this population of infants,” Wachman says. “If you can imagine, this is an incredibly difficult population to study. To do a randomized, controlled trial, for instance, of opiates and neonates is incredibly challenging.”
Dr. Jackson acknowledges the challenges but says establishing consistent practices based on what doctors do know is an important first step in answering questions.
When Lili was born, Victoria Worden says she did everything she could to help her daughter get healthy in the hospital. But she had no idea what would happen next.
“I was trying not to be connected with her, because, I thought, they’re probably going to take her,” Worden says. “I haven’t been clean that long. So I was trying to not, like, be in love with her. But I was so in love with her.”
Since showing state officials that she was committed to staying clean, Worden has been allowed to raise her daughter in Amethyst Place, a recovery home in Kansas City.
At 16 months, Lili today shares her mother’s blonde hair, bright eyes and big smile. And despite her tough start in life, the toddler is now the picture of good health – and her mom has been sober for more than 18 months.
Worden says that recovery, once so painfully difficult, has changed the way she looks at life and at herself.
“I’m trying to better myself, not just financially, but just to be a better person,” she says. “I really enjoy looking in the mirror now. I really like who I am.”
Alex Smith is a health reporter for KCUR. You can reach him on Twitter @AlexSmithKCUR