Babies with neonatal abstinence syndrome and their mothers should be placed in the same hospital room, where possible, and not assigned to the Neonatal Intensive Care Unit (NICU), according to the Canadian Pediatric Society (SCP).
The medical organization on Thursday issued new recommendations for doctors and hospitals on the care of these vulnerable newborns and their mothers, in response to the growing number of babies exposed to opioids before they were born.
“Several weeks of separation could damage the very first emotional ties and attachment, and aggravate an already painful situation for both mothers and their babies,” said Dr. Thierry Lacaze, the chair of the study committee of the fetus and newborn baby from the CPS.
“It has been shown that leaving mothers and children together can reduce the number of admissions to NICU, promote breastfeeding, reduce the length of hospital stay and reduce the use of prescription medications,” he added.
In 2016-17, approximately 1850 babies were born after being exposed to addictive drugs during their mother’s pregnancy, a 27% jump over the 2012-2013 period, according to data from the Canadian Institute. health information.
A good portion of these neonatal abstinence syndromes have been associated with opioids such as oxycodone, hydromorphone, and fentanyl.
Dr. Lacaze, who heads the neonatal program at the University of Calgary, says babies usually experience the first symptoms of weaning between 12 and 24 hours after birth, including extreme irritability and eating and sleeping problems.
“In the worst cases, these babies can also suffer from convulsions,” he said.
Between 50% and 75% of babies born to opioid-dependent mothers will need care for their withdrawal. Decreasing doses of morphine are usually given to the baby until he can do without it.
However, cohabitation between mother and child can greatly reduce the number of babies who will need morphine, since breastfeeding will provide a small dose of the product, which helps control withdrawal symptoms, said Dr. Lacaze .
“You have to work for the first few hours after birth to get the breastfeeding right, so that the babies are with their skin-to-skin mother in a calm environment,” he said. And it’s fantastic … It works. Separation is not necessary, medication is not needed, and obviously there is a huge cost impact because these babies do not need to go to the NICU. It’s a profound change. ”
Neonatal abstinence syndrome occurs in babies whose mothers were taking opioids illegally or to control pain, or born to women whose drug addiction was treated with methadone or buprenorphine.
Neonatologist Kimberly Dow, the medical director of the Kingston Health Sciences Center’s UNSI, explains that withdrawal symptoms in the baby can include tremors, nervousness, vomiting, diarrhea, rapid breathing, fever, sneezing and sweating.
“But the worst of what I see is how inconsolable they are,” she says. They cry and cry and cry. ”
The hospital usually transferred these babies to the NICU, but a cohabitation program was implemented in 2013 and two years later, a study comparing the two approaches was published by the American Journal of Perinatalogy.
“We found that 83% of babies admitted to the NICU needed morphine to control their withdrawal, compared to 15% of those in the cohabitation program,” said Dr. Dow. As a result, the length of stays has been greatly reduced from an average of 24 days at UNSI to just five days for cohabitation. ”
A 2014 CPA survey found that 52% of neonatal units in Canada now had a cohabitation program for mothers and babies with opioid withdrawal. The pediatric group is now encouraging other hospitals to do the same.
“I think it’s essential,” says Dr. Dow. I really think it’s the most important component of care for these babies. “