Beyond Detox: Helping drug-exposed babies beat the odds

"Health and education have been called two sides of the same coin — you can’t embrace education if you’re unwell," says Amy Slancik, director of The Learning Network of Greater Kalamazoo. And that includes being unwell at birth -- like the growing number of babies who enter the world suffering withdrawal from drugs, particularly those with Neonatal Abstinence Syndrome (NAS).

NAS is the withdrawal process newborns endure after being exposed in the womb to opioids: a class of drugs including morphine, hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), codeine and other drugs frequently prescribed for pain management – as well as heroin.

It’s a distressing start to life: NAS can inflict a range of miseries on infants, from tremors, excessive and high-pitched crying, sleep problems, tight muscle tone and hyperactive reflexes to seizures, poor feeding and sucking, vomiting, diarrhea, dehydration, sweating and fever. Many require morphine or methadone to ease the detox process. And weaning off those medications can mean days or weeks in the Neonatal Intensive Care Unit, says Robin Pierucci, MD, a Bronson Methodist Hospital neonatologist.
 
Yet treatment in the NICU is just one piece of a bigger picture. "To adequately care for any infant with NAS, we can’t just treat the baby," Pierucci says. "This problem is way bigger than just what happens in the NICU. It’s too big for one discipline to solve."

Enter the Kalamazoo County NAS Prevention and Treatment Project, a consortium of area medical professionals, local government, and community service providers seeking to create a reliable, compassionate system of care for NAS infants and their mothers. The goal: To optimize childhood development and family functioning so these vulnerable babies can reach their full potential.

Launched in 2012, the project was funded by a grant from The Learning Network, with support from the W.K. Kellogg Foundation and Kalamazoo Community Mental Health and Substance Abuse Services.

With The Learning Network’s commitment to lifelong learning, it made sense to invest in improving NAS outcomes, Amy Slancik says. "The project addresses both infant and maternal health issues within one initiative. Just as significant, we were one of dozens of partners at the table, making this a community-wide project and increasing its chances for long-term sustainability."

Participants include area hospitals, physicians, mental health providers, substance abuse professionals, early childhood educators, social workers, toxicologists, and the court system. (Full list below.)

Streamlined support

These partners are working together more effectively to create and connect to needed services, like a universal screening tool for early intervention. The project also has changed how babies at risk for or diagnosed with NAS are identified, managed after birth and then connected with resources. Before, a baby discharged from the NICU might end up seeing a pediatrician who didn’t know the child had NAS. New protocols try to ensure that everyone who interacts with the babies and moms knows what each provider is doing, the treatment steps to take and what community resources are available. "It is so amazing to watch the numbers of different groups that are truly coming together. In the community piece, we’re far ahead of some other places," Pierucci says.

Results of this cooperation include simplified referrals, free community training sessions for more than 100 medical and childcare personnel, a "Baby Behavior Booklet" for moms and a pediatrician checklist.

All this progress was made possible by "the relationships built between organizations and service providers -- relationships that either didn’t exist before or that increased or improved during the project," says Dianne Shaffer, program manager of services for youth and families at Kalamazoo Community Mental Health & Substance Abuse Services.

After withdrawal
 
"There’s been some early success in getting these babies off all their meds more quickly than we had before," Pierucci says. But completing detox isn’t the end of the problem. It’s too early in the research stage to know exactly how opioids affect the brain in utero, but Pierucci suspects some serious neurological rewiring may be taking place – especially considering mothers using opioids also may be smoking, drinking alcohol or using more than one drug.

"We have to follow these kids," she emphasizes. "The period from age zero to 3 is when the brain is the most plastic it will ever be. So we’re hoping to be able to make an impact by getting these babies hooked up more consistently with groups like Early On and occupational or physical therapy."

Though hard data isn’t available yet, "my guess is that NAS affects learning," Pierucci says. "I hope that not only will we become better at identifying and treating it in infancy, but we’ll figure out ways to help these kids so they don’t have core problems later on."

Tuesday Triage, early therapy

Fortunately, Kalamazoo County is rich in early education resources for vulnerable kids. Among them are Kalamazoo Regional Educational Service Agency’s home visiting programs: Ready, Set, Succeed! , Great Start Plus and Early On.

All participate in "Tuesday Triage," a weekly meeting of child health and welfare agencies who sort through referrals for home visits or intervention and determine the best program to respond. Babies identified as opiate- or methadone-exposed at birth are enrolled in the NAS process and monitored for that developmental need, says Kristi Carambula, KRESA’s director of early childhood programs and a member of the NAS project.

"We know early intervention in supporting the caregiver with soothing and calming techniques is vital for a baby’s ability to learn to self-soothe and develop healthy sleeping and eating patterns," Carambula notes.

"Plus, supporting the mother … in curbing her own exposure to substances (prescribed or otherwise) will help build the maternal-infant attachment and bonding process, which benefits the child socially and emotionally. Left unaddressed, these children can have long-term issues related to behavior and ability to learn."

In a new initiative, a group of occupational, physical and music therapists from Western Michigan University will be working with children at Victory Clinical Services, a methadone program, when their mothers come in for treatment. It’s convenient for the moms and "there’s a real chance we can make a difference in helping these babies, neurologically," Pierucci explains.

Formal funding of the NAS project ends June 30, but several members plan to meet regularly to discuss the data being collected. "We’re at the tip of the iceberg," Pierucci says. "It’s an ongoing problem to truly figure out more and more precisely what we need to do, and the best way to help these babies and their families." 

Cathie Schau is a freelance writer, communication consultant and writing tutor. Recently she helped coordinate the NAS Prevention & Treatment Project's public awareness effort. 

Partners in the Kalamazoo County NAS Prevention and Treatment Project

•   Borgess Medical Center
•   Borgess ProMed Pediatrics
•   Borgess Women’s Health
•   Bronson Healthcare
•   Bronson Rambling Road Pediatrics
•   Bronson Women’s Services
•   Catholic Charities
•   Children’s Trauma Assessment Center
•   Community Healing Centers
•   Family Health Center
•   Kalamazoo Community Mental Health & Substance Abuse Services
•   Kalamazoo County Department of Human Services
•   Kalamazoo County Health and Community Services
•   Kalamazoo Regional Education Service Agency
•   Parent to Parent
•   Prevention Works
•   Victory Clinical Services
•   Western Michigan University Homer Stryker M.D. School of Medicine