Babies exposed to opioids are expected to stay with their mother

Photo: Jacques Nadeau Archives The Duty

The canadian paediatric Society has released new recommendations in response to the growing number of babies exposed to opioids prior to birth.

Babies who have a neonatal abstinence syndrome and their mothers should be placed in the same hospital room, when this is possible, and not entrusted to the neonatal intensive care unit (NICU), according to the canadian paediatric Society (CPS).


The medical organization has published on Thursday new recommendations for physicians and hospitals regarding the care of these newborns are vulnerable and their mothers, in response to the increasing number of babies exposed to opioids prior to birth.


“Several weeks of separation could be detrimental to the earliest bonding and attachment, and worsen a situation that was already painful as well as for mothers as for their babies,” said dr. Thierry Lacaze, the chairman of the study committee on fetus and newborn of the SCP.


“It has been demonstrated that leaving the mothers and children together can reduce the number of admissions to the NICU, promote breastfeeding, reduce the length of hospital stay and reduce the use of prescription drugs “, he added.


In 2016-2017, and about 1850 the babies are born after being exposed to dependency-producing drugs during their mother’s pregnancy, a jump of 27% compared to the period 2012-2013, according to data from the canadian Institute for health information.


A good portion of these syndromes of neonatal abstinence has been associated with opioids, such as oxycodone, hydromorphone and fentanyl.


Dr. Lacaze, who directs the program, neonatal, University of Calgary, says that the babies are usually the first symptoms of weaning between 12 and 24 hours after birth, especially extreme irritability and feeding problems and sleep.


“In the worst case, these babies may also suffer from convulsions,” he said.


Between 50 percent and 75 percent of babies born to mothers who have an opioid addiction, will need to care for their withdrawal. Decreasing doses of morphine are usually administered to the baby, until it can pass.


The cohabitation between the mother and the child, however, can greatly reduce the number of babies who will be in need of morphine, since breastfeeding will provide them with a small dose of the product, which helps to control the symptoms of withdrawal, explained dr. Lacaze.


“You have to work during the first hours after the birth to fully install breastfeeding, for babies to be with their mothers skin-to-skin in a quiet environment, he said. And it is fantastic… It works. The separation is not necessary, the medication is not necessary, and, of course, there is an impact on costs, because these babies do not need to go to the NICU. This is a profound change. “


Neonatal abstinence syndrome occurs in babies whose mothers took opioids illegally or for pain control, or born to women whose addiction was treated with methadone or buprénophrine.


The neonatologist Kimberly Dow, the medical director of the NICU of the Centre of health sciences, Kingston, explains that withdrawal symptoms in the baby may include tremors, nervousness, vomiting, diarrhea, rapid breathing, fever, sneezing and sweating.


“But the worst of what I see is at what point they are inconsolable,” she said. They cry and cry and cry. “


The hospital transferred usually these babies to the NICU, but a program of coexistence has been implemented in 2013 and two years later, a study comparing the two approaches has been published by the American Journal of Perinatalogy.


“We found that 83 % of babies admitted to the NICU were in need of morphine to control their withdrawal, compared with 15% of those in the program together”, explained dr. Dow. As a result, the duration of stays has been significantly reduced, from an average of 24 days in the NICU for five days only for cohabitation. “


A survey conducted by the SCP in 2014 found that 52 % of neonatal units in Canada has had a program of living for mothers and babies suffering from an opioid addiction. The pediatric group now encouraging other hospitals to do the same.


“I think it is essential, says dr. Dow. I really think that this is the most important component of the care of these babies. “