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Eat, Sleep, Console: Asante tries new approach with addicted babies

By Vickie Aldous

Mail Tribune

Babies born addicted because of their mother’s drug use usually are whisked away to the neonatal intensive care unit, where they receive morphine or methadone to combat vomiting, tremors and other symptoms of withdrawal.

But drawing on recent scientific research, Asante this month formally launched a new way to treat addicted newborns at Rogue Regional Medical Center in Medford and Three Rivers Medical Center in Grants Pass.

Asante Ashland Community Hospital will transfer its newborns going through withdrawal to Medford.

Under the new model, babies stay with their moms, who snuggle, comfort and feed them while hospital staff and volunteers offer assistance and education about how to care for these high-need newborns.

“The new model takes the parent and makes them the primary caregiver for the baby,” said Michelle Catheart, registered nurse and manager of the neonatal intensive care unit and pediatrics at Rogue Regional Medical Center.

Yale-New Haven Children’s Hospital researchers who studied groups of addicted babies in 2014 and 2015 found the babies who remained in their mothers’ arms spent an average of 5.9 days in the hospital and received less morphine.

Babies taken away to the neonatal intensive care unit were stuck in the hospital more than three times as long — an average of 22.5 days.

The new approach at Asante is called the Eat, Sleep, Console model.

Emily Barnes of Ashland already was a volunteer cuddler for Asante, holding babies who need extra attention.

She jumped at the chance to volunteer in the Eat, Sleep, Console program.

“It’s an opportunity to give a little bit more,” Barnes said.

In addition to cuddling babies, Eat, Sleep, Console volunteers help with other tasks, such as feeding and diapering.

Cuddling will remain a key activity for the 18 volunteers who have stepped forward so far.

Babies going through withdrawal often seem inconsolable, with excessive high-pitched crying and an inability to sleep for long.

“I can come and give that warmth and that heartbeat and I can console them and nurture them in this early stage,” Barnes said.

With some babies unable to sleep for more than 45 minutes at a time, volunteers and medical staff are needed so that new mothers can rest, said Hilary Redden, a neonatal intensive care unit physician.

Addicted babies frequently have a tough time coordinating the sequence of sucking, swallowing and breathing necessary to nurse, said occupational therapist Debbie Archer.

Whether as babies or adults, people have to hold their breath while sucking in liquids and swallowing. They begin breathing again once the liquid is safely down the esophagus.

This rapid cycle of sucking, swallowing and breathing has to be repeated over and over again in a coordinated rhythm by a nursing baby, Archer said.

But while addicted babies show a frantic desire to suck, they often lack the coordination needed to nurse successfully, she said.

Symptoms of withdrawal can also include stiff muscles, twitching, convulsions and rapid breathing.

But other symptoms can appear in perfectly healthy newborns, including yawning, sneezing, nasal stuffiness and sweatiness.

For decades, hospitals have relied on a Neonatal Abstinence Score Sheet that listed withdrawal symptoms from projectile vomiting to yawning. A baby exhibiting too many symptoms was admitted to intensive care.

Under the new model, Asante instead looks at how well a newborn can function, said Hillary Handelsman, perinatal clinical practice adviser at the Rogue Regional Medical Center Family Birth Center.

Can the baby eat, sleep and be consoled? If not, what care and support can be provided so the baby gains those skills while staying with the mother?

If needed, babies can be given morphine orally to combat withdrawal symptoms as they snuggle with their moms.

Compared to the bright lights, noise and activity of the neonatal intensive care unit, staying in a room with a mom is a cozier environment.

Like other newborns, babies going through withdrawal are often soothed by an environment that resembles the womb. Swaddling makes the baby feel snug, while white noise machines can replicate the sounds heard from within a woman’s body.

Kohl’s has donated $100,000 over two years to help support the Asante program and send new moms home with white noise machines and other supplies that will help them care for their babies.

Handelsman said while the moms are still in the hospital, medical staff members teach partners, family members and others in the women’s support systems about how to help care for the infants.

Learning what to expect and how to properly care for a difficult baby reduces the risk of depression, feelings of failure and inadequacy, frustration and potential abuse, Handelsman said.

Nationwide, the country is dealing with an epidemic of addiction to opioid prescription pain pills and heroin. Every 15 minutes, a baby is born with withdrawal symptoms.

The number of babies going through withdrawal has increased fivefold over the past 10 years, Asante officials said.

Locally, about six babies per month are born with withdrawal symptoms at Asante’s hospitals in Medford and Grants Pass, Handelsman said.

Rather than quitting cold turkey, women who start their pregnancies addicted to prescription or illegal opioids are often advised by their physicians to continue on a steady dose of addiction treatment medication like methadone or Suboxone, Handelsman said.

“The largest danger is relapse,” Redden said.

Pregnant women battling addiction who relapse may take a dangerous level of drugs, putting themselves and their babies at risk, she said.

Those unsteady spikes of drugs are more dangerous to the baby than a steady supply of medication used under the guidance of a health care provider, Redden said.

After a baby is born, women who are on medication are encouraged to breastfeed so some of the medication passes to the infant, said Sarah Struebig, a registered nurse and lactation consultant for Asante.

Struebig said many women facing addiction want to make changes in their lives and are very motivated and eager to learn how to mother their babies.

“We’re really doing a lot of teaching,” she said.

Redden said Asante is excited to be a pioneer among Oregon hospital systems in adopting the Eat, Sleep, Console model for babies going through withdrawal, which is medically known as neonatal abstinence syndrome.

“I expect this will be the way NAS babies will be cared for in the future,” she said.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her at www.twitter.com/VickieAldous.

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