The opioid crisis hits the most vulnerable: babies

The overdose crisis has hit all ages – from older people to newborns.

The effects of the heroin crisis are devastating, no matter whom it’s impacting.

But for newborns – that can put a pit in your stomach like no other.

Children born dependent on opioids like heroin or OxyContin require lots of care, and a long stay in the neonatal intensive care unit.

“The mothers are upset. And understandably so. There’s a lot of guilt that they have about this whole condition because they feel that they brought it on their babies,” says Dr. Manny Peregrino, the head of the neonatal unit at Pinnacle’s Harrisburg Hospital, where more than 4,000 babies are born every year.

The start of a long stay in a hospital

All babies start on the ninth floor, but when a baby is diagnosed with neonatal abstinence syndrome, it’s almost always transferred to the the eighth floor, where the neonatal intensive care unit is located.

The NICU is split up into a handful of rooms with about 8 beds in each one.

There’s a cluster of machines next to each baby’s bed.

Parents quietly sit by, sometimes cuddling their baby, or just gazing at them laying on the tiny, tiny beds.

Minus the occasional beeping, it’s actually pretty quiet.

Once babies with neonatal abstinence syndrome are brought under control, they really calm down.

The syndrome – also known as NAS – is caused when a pregnant mother takes opiate or narcotic drugs like heroin, oxycodone, methadone, or buprenorphine.

The fetus gets addicted to the drug, and once the baby is born, it starts going through withdrawals.

Doctors use a formula to determine if the newborn should be held past the usual stay because they suspect it has NAS.

“When the time comes, and we’ve made the determination that the baby needs the treatment, it’s at that point generally not a surprise for the mother. She has seen, before her own eyes, what has gone on over the last 1-5 days,” says Dr. Peregrino.

This is critical work – newborns with NAS may not live very long. 

Pennsylvania doesn’t have reliable data on it for everyone, but in Medicaid, about 3,700 babies were born with NAS over the past two years.

31 died before their first birthday.

What treatment involves

At Pinnacle, this baby is sitting in a pretty bare, simple room, sleeping in a rocker known as a mamaRoo.

“A lot of these babies will require cuddling or holding,” says Dr. Peregrino.

“Not necessarily a high tech intervention, but a very important one to keep them calm. You’ll see some of our babies with neonatal abstinence syndome being carried around the unit in the evening sometimes, in little slings. They seem to like that, especially as they get a little older.”

There’s also drugs involved.

At Pinnacle Hospital, that typically means morphine, which is one of the most commonly used treatments across the country for NAS.

These infants have a tendency to be very irritable,” says Dr. David Wolf, a neonatologist in Pinnacle’s Harrisburg Hospital NICU. “It takes a certain type of person to be able to deal with them.”

The nurses will check on a baby with NAS every couple of minutes.

It’s almost constant work, says Dr. Peregrino.

“It’s not unusual for babies with NAS to require or take in very high volumes of feeding and we will typically use, if we’re not using breast milk, special formulas that are a little easier for them to digest.”

This intensive care – the medication dosing, and the constant monitoring – all of this happens over the course of two, three, sometimes four weeks or more.

And it can cost tens of thousands of dollars.

Pinnacle’s Dr. Wolf admits it’s a long process, and a long time in the hospital for a baby.

“We like to get them out as soon as we can. Ultimately, that timeline is driven by the baby and how well they tolerate weaning off the medication. Each case is very different.”

When the baby is ready, it’s discharged – sometimes to its biological parents, other times to relatives or a foster family.

Follow up visits will be scheduled and the child’s condition will be monitored.

And so for that child’s first few years, the work of undoing the damage done by the disease of addiction will continue.