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Addicted to Drugs at Birth

Representatives from Wheeling Hospital, area child protective agencies and drug prevention groups are teaming up to identify and help infants affected by Neonatal Abstinence Syndrome and to encourage prospective parents to reduce the risk of their children’s exposure to drugs.

“Neonatal Abstinence Syndrome is the physical condition demonstrated by a newborn infant when the placental supply of narcotics is disrupted at birth,” Dr. Judith Romano of Wheeling Hospital explained. When the effects of the drugs stop suddenly, the baby may develop withdrawal symptoms.

Wheeling Hospital’s nursing staff and Center for Pediatrics conducted a Neonatal Abstinence Syndrome roundtable last week with Child Protective Services workers handling cases in Belmont County in Ohio and Brooke, Hancock, Ohio, Marshall, Wetzel and Tyler counties in West Virginia. Participating in the discussion with CPS representatives were nurses, physicians and social workers from the hospital.

A nationwide increase in babies born with NAS, or drug withdrawal, has led hospitals to adopt special guidelines for helping parents and families care for affected infants. At Wheeling Hospital, pediatric nurses have received specialized training in dealing with these infants, their mothers and families.

Cara Gazdik, nurse manager of Wheeling Hospital’s nursery and pediatrics unit, explained that the departments’ project for the year is to address the issue of infants being born with exposure to drugs, whether prescribed or illicit. The nursing staff has developed an “All-Star Team Approach” to the challenges of caring for newborns of drug-addicted mothers, she said.

The nursing staff compiled a list of questions, beginning with the issue of when to call Child Protective Services. The workers responded that nurses or physicians should notify the agencies, which will then make a determination on the referral, based upon the respective state’s policies. When a referral is accepted, Child Protective Services may monitor the situation in the home or, if circumstances warrant, a court order could be sought to place the infant in foster care.

Child Protective Services workers in West Virginia said if a mother or baby has tested positive for drugs, authorities have to prove that the baby is unsafe before removal from the mother’s care. Additional investigation is warranted if the mother has other children in the home who may be exposed to any drug use.

In West Virginia, a positive-testing newborn can go home if the parent or a grandparent is able to maintain safety in the home. “If we can keep a child safe in the home, we are obligated to keep the child in the home,” a CPS official explained. State and federal guidelines call for families to remain together or be reunited when appropriate.

Under state law in Ohio, “we need to have an allegation … We need to have something more concrete,” workers there said. In Ohio, a positive drug test in utero does not constitute an allegation; Ohio law mandates that an allegation be based on results at birth or later in the child’s life. “If a child tests positive for drugs, that is an automatic filing in Belmont County,” one worker said.

Efforts to help expectant mothers begin early if they are under an obstetrician’s care. Every pregnant patient undergoes a drug screening initially, said Dr. Catherine Coleman of Wheeling Hospital. “If it’s positive, I talk to them. I’ve heard every story,” she said. Coleman said she will continue to screen the patient if she is non-compliant with directives to stop drug usage or if she misses a lot of appointments.

Newborn babies’ umblical cords are sent for drug testing, and the cord results are sent to their pediatricians for a follow-up visit, Gazdik said.

To improve communications between authorities and medical personnel, Wheeling Hospital nurses document when CPS workers visit the nursery or see the mother in the obstetrical unit, Gazdik said.

To educate families about Neonatal Abstinence Syndrome, Wheeling Hospital’s Center for Pediatrics has prepared and distributed a guide for expectant mothers and a guide for new parents. The pamphlets contain information on how certain drugs affect a baby during pregnancy and after birth, how to prevent NAS, how to understand the meaning of withdrawal and how to care for babies who have the syndrome.

“As opiate drug addiction has swept through the Ohio Valley, our most vulnerable victims are unborn,” Romano said. “Intrauterine drug exposure has unfortunately become a frequent morbidity associated with opiate addiction. Maternal drug use during pregnancy in the Ohio Valley is on the rise and could be as high as 32 percent.”

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After Romano noticed dramatic numbers of drug-exposed pregnancies in her practice, she wanted to involve her obstetrics colleagues in prevention. Romano contacted Stephanie Barnett, a Maternal Infant Health Outreach Worker, about the problem.

A collaboration was launched with Youth Services Systems’ prevention services program in Wheeling. Dara Pond, YSS prevention services senior project coordinator, acted as lead writer on a grant to pilot a program to reduce prenatal drug exposures.

Regarding this effort, Martha Polinsky, project coordinator for the Ohio County Substance Abuse Prevention Coalition, stated, “The long-term hope would be a decrease in post-birth infant drug withdrawal requiring medical treatment and healthier pregnancies.

“The program’s short-term goals begin with protocol to identify and refer pregnant patients with substance abuse problems to treatment. The long-term hope is to, eventually, hire a dedicated social worker to be assigned to the identified patients to offer help and support during the pregnancy,” Polinsky said.

The group was awarded funding through the Community Foundation for the Ohio Valley’s Community Impact Fund to begin the proposed program. “More funding is needed to reach all the goals, but this newest funding provides seed money for the program,” Polinsky said.

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Drugs that can cause Neonatal Abstinence Syndrome include prescription medication, such as morphine, Percocet, Subutex, Methadone, Fentanyl and Oxycontin, and street drugs including cocaine, crack, speed, ecstasy and heroin.

Roundtable participants said drug users who are taking Methadone or other prescribed medication to curb their addiction often don’t realize that those drugs also affect their babies. Doctors and social workers said they try to educate pregnant women about this reality and offer them practical information.

“It is not possible to predict which babies will have withdrawal or how long it will last,” Gazdik said. “The baby may need to stay in the hospital for a few days or several weeks, depending on the treatment required.”

Nurses at Wheeling Hospital have specialized training to assess and care for babies with NAS. At the hospital, parents are taught specific methods for understanding the needs of NAS babies and providing the proper care.

Special care for NAS babies includes providing a quiet and calm environment with low sounds and dim lights; holding the baby skin-to-skin or bundling the infant firmly in a soft blanket; determining the proper way to feed the baby; soothing the infant by rocking and gently rubbing his or her back.

“We also provide social workers for support during pregnancy and after the baby’s birth,” Gazdik said. “This helps the mother and family cope with life challenges and connects them to helpful resources in the community.”

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