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Health care adapts to care for babies affected by drug use

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When Carla Spangler was in nursing school, neonatal abstinence syndrome wasn’t on the syllabus.

NAS is what happens when a fetus or infant has been exposed to opiate drugs taken by the mother and is physically dependent on a substance, suffering withdrawal symptoms. It was first described in the 1970s in women who used heroin or took methadone to recover from narcotic drug addiction.

Spangler, who has been a nurse for 25 years — 17 of them at WVU Medicine’s Ruby Memorial Hospital, sees cases of NAS regularly as the specialty care nurse in the neonatal intensive care unit.

“In training 25 years ago, it was not a consideration,” Spangler said. “Nowadays it’s more prevalent. I think drugs are more accessible now. They’re easier to get and people are willing to try more things. 

“Even 10 years ago (NAS) wasn’t prevalent or at least we didn’t know it was a problem. Drugs are a huge, huge problem in this world today.”

Drugs have changed society and health care has changed to treat the problems drug use causes. Specifically, neonatology has enacted innovations including drug testing, volunteer caregivers and separate residential recovery centers for newborns.

Delivery room drug tests

One in every five babies delivered at Ruby Memorial has been exposed to some kind of drug used by the mother, Spangler said. Twenty percent to 30 percent of babies get treated. 

Routine drug testing is one of the biggest changes Spangler said she has seen in her job in just the last couple of years. It has evolved from screening the mother’s urine for drugs and testing the baby’s first stool, to testing blood from the umbilical cord to detect drugs that don’t show up. 

“We do umbilical drug screening on all mothers at WVU,” she said. “President and Mrs. Obama could come here to have a baby and we would still take a cord blood sample. At WVU everybody gets a cord sample done.”

That’s because it can take between 24 hours and 72 hours for withdrawal symptoms to show up in a newborn, and sometimes babies were home before symptoms appeared. Now, if the cord blood tests positive for drugs or the mother tells the staff she is using street drugs or Subutex or Suboxone — medications prescribed to treat opioid dependence — the baby will stay in the hospital so the NICU can treat it for withdrawal.

Symptoms of withdrawal in infants can include high-pitched wailing, tremors and involuntary spasms, sneezing fits, sweating, explosive diarrhea, painful rashes and poor sleep. They can choke while eating.

Called to cuddle

Newborns with NAS are more difficult to calm than typical babies. Their own movements can frighten them and the smallest sounds can startle them.

Hospital nurses often have more than just one infant to tend to, as well as recordkeeping and other duties. To help them and to give NAS babies more one-on-on, care, many hospitals have started volunteer cuddler programs. WVU Medicine has one; so does United Hospital Center in Clarksburg.

“It’s just really helpful to the staff and helpful to the baby to have unhurried time,” said Denise Steffich, UHC’s auxiliary coordinator and director of volunteer services.

Steffich said the nurse manager has told her the staff doesn’t see many babies exposed to cocaine or marijuana. Most are withdrawing from opiates or methamphetamine. She said the average length of hospital stay for a baby with NAS is 21 days, but some have been in the NICU longer. One stayed 55 days. And during that stay, it’s not always possible for a parent or grandparent to be there at all times.

“There are definitely people who love to love on babies,” Steffich said.

Two of UHC’s 27 cuddlers are men, she said, and there are 15-18 people on the waiting list to be cuddlers. Most are between ages 30 and 50. Some are working and others are retired. Some may be women who have lost their own children. Others are grandparents. Steffich said the thing they have in common is a desire to give back to the community.

Volunteers have to be at least 22 years old, pass a background check and obtain certain immunizations, Steffich said. A CPR certification is desirable but not required. All the cuddlers sign confidentiality agreements promising to not talk about the babies or their situations. Cuddlers are not allowed to feed babies or change their diapers. 

“They are holding and rocking,” Steffich said. “The babies are brought to and picked up from the cuddler in a room across from the nurse’s station. They are not really moving around, and they have specific instructions on how they are to deal with the baby. They can cry inconsolably but the majority of babies are happy or sleeping.”

There is quite a bit of orientation, she said.

“They want you to hold it preferably in a cradle position with its head resting on your arm,” said Deneane Reneau, one of the first volunteer cuddlers. “You’re allowed to take music, so I have taken my iPad and Bose speaker. Typically I listen to music and I just sit there and hold the baby. For the most part, they’ve usually just slept. It’s very peaceful. I love it when the babies open their eyes and look at you and you can talk to them.

“I have probably surprised people that I can do that and not get attached,” Reneau said. “I went in knowing I have a role. If I cuddled the same baby five times there would be some attachment there, but I think I’ve held the same baby only two or three times. I know I’m helping them. My purpose is to cuddle the baby and keep it comfortable so it continues to sleep and be at peace.”

Reneau, of Grafton, has taken vacation time from her job as a training instructor for the FBI when she has been called to cuddle. She has two sons long out of diapers: a 24-year-old Navy officer and a 14-year-old.

The cuddlers are on call as needed and can decline if they are unable to go to the hospital when called. Karen Betler, a cuddler who lives in Nutter Fort, likes that flexibility, especially when she’s traveling.

“I thought, ‘If I can make a little baby happy for a few hours, it would be worth the time,’” she said. Cuddlers spend one to two hours with the babies and occasionally longer. Once, Betler was there four hours.

“I like the satisfaction of knowing that you’re helping somebody that can’t help themselves and speaking for someone who can’t speak for themselves,” she said.

Betler has been a Court-Appointed Special Advocate for children for 19 years, volunteering her time to make a connection with and speak up in court for more than two dozen children. 

“From the time I came to CASA until now, in 19 years, I have seen such a difference. It used to be kids got taken away because their parents weren’t taking care of them, maybe dad was beating on mom, but now it’s so many drugs. Drugs and alcohol have just taken over.”

Lily’s place

Lily’s Place, a residential infant recovery center in Huntington, has a dual mission.

“The primary focus of Lily’s Place is the baby,” said Executive Director Rebecca Crowder. “But we cannot help the baby without helping the parents, foster parents, adopted parents or grandparent who may be the primary caregiver for the infant. All of these have received wrap-around services that assist in assuring a healthy and successful future.

“With our education and outreach efforts we are working to end the epidemic of addiction and decrease the amount of babies born prenatally affected by drugs. By educating people about the risks involved with drug use and the effects it has on unborn babies we hope to decrease and prevent substance abuse.”

Since Lily’s Place opened in October 2014, it has served 112 babies and their families, Crowder said. Upon discharge, about 80 percent of mothers are doing well in their recovery from substance abuse.

The locked, secure facility has a 1:2 staff-to-patient ratio, she said. The babies, who are easily startled by noises, have private nurseries. 

“Our facility is set up like a home environment where each nursery provides a home type of atmosphere that is conducive to the low-stimulus environment needed for a baby going through the weaning process,” Crowder said. “Lily’s Place is only one of two such facilities in the United States. And we are the only one that offers help and support to families.”

By the time a baby is discharged, the staff has trained the child’s caregivers in therapeutic handling, infant CPR, caring for a high-needs infant, including how to feed an NAS baby and safety precautions, including safe sleeping practices.

Lily’s Place also provides information to the community on local and social media and at points of service like methadone clinics, OB/GYN offices and health departments, Crowder said. Staff connects the families it serves with drug rehabilitation services and community resources to meet needs. 

The facility follows up with the families after discharge to ensure medical and social needs are met and the social worker performs home visits.

“These are services that do not have an end date,” Crowder said. “We will continue to serve the children and families for as long as they need our services.”

This story first appeared in the print edition of The State Journal. Click HERE to subscribe.

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