Ohio babies born into addiction up 750 percent

Sometimes, Carole Pickworth-Campbell goes home to Johnstown after a day volunteering at Nationwide Children’s Hospital and cries.

Her tears come after hours of trying to console the cries of the smallest Ohioans hurt by the opiate epidemic.

Since 2004, the state has seen a 750 percent increase in the number of babies diagnosed with neonatal abstinence syndrome; essentially withdrawal from the drugs their mother used. On average, there were five drug-dependent babies admitted to Ohio hospitals each day of 2013 with 87 percent of them on Medicaid, according to a recent report from the Ohio Department of Health.

While the numbers of babies born drug-dependent continue to climb, there is at least one glimpse of light as hospitals find ways to better treat these infants and connect with addicted mothers before they give birth. The average hospital stay for drug-dependent babies has dropped from a 20-day peak in 2008 to just under 15 days in 2013. Those stays cost nearly $98 million overall with the bulk coming from Medicaid.

One of the approaches to increase results and decrease costs is boosting human contact. In January, Children’s began training select volunteers, Pickworth-Campbell is one of eight so far, to provide more contact for the babies.

“It seems like the addicted babies just curl into you, they really need it maybe more than the others,” she said.

Baby steps

The first time Pickworth-Campbell held and rocked a baby suffering drug withdrawal, she didn’t even know. After rocking him about 90 minutes, she lay him in his crib to rest and was startled when he began to scream inconsolably.

“I thought it was all my fault and I felt so bad. I tried to pick him up again and he was just screaming, stiff, and three nurses came in and took care of him immediately,” she said. “I felt like I should’ve held him longer; I should’ve not let that happen. The next time I came in I went right to his room and I held him for four and a half hours.”

The crying and stiffness are just a few of the common characteristics of neonatal abstinence syndrome. In 2013, about 26 percent of those babies in Ohio had low birth weight; 25 percent had respiratory issues; 15 percent had troubles feeding and 1 percent suffered seizures.

The number of babies with those symptoms has steadily decreased since 2007 and, subsequently, the statewide average length of stay in the hospital has decreased since it peaked in 2008.

Gail Bagwell, a clinical nurse specialist who does perinatal outreach at Nationwide Children’s Hospital, credits those results with a statewide effort through the Ohio Perinatal Quality Collaborative to get everyone on the same page. The effort began in 2008 when the average length of stay peaked and the NAS initiative kicked off in 2013 with a goal to reduce that average 20 percent by June 30, 2015.

“We looked at how we were treating them and what we realized was that every physician had their own way they wanted to treat these babies that had been exposed to drugs ... So we developed a (treatment) protocol,” Bagwell said.

Part of that protocol involves consistent evaluation of babies and different approaches, such as swaddling, rocking and music therapy, before resorting to using methadone or morphine to treat the withdrawal symptoms.

“That’s really been critical in our state because nationally it’s been a problem in knowing how to treat (drug dependent babies),” said Brad DeCamp, chair of the State Opioid Treatment Authority.

When Nationwide Children’s received a grant from Cardinal Health Foundation to help develop treatment protocols, Kelly Kennedy, a registered nurse who orients volunteers, suggested creating a select group of volunteers specifically trained to help provide additional contact with drug-dependent babies. Prior to the program’s start, the only way to get that additional help was with the use of paid bedside aides, which became more difficult to do and costly as the numbers of affected babies increased.

Bagwell consulted with East Tennessee Children’s Hospital to get information about their volunteer program and adapted it for use in Columbus. In order to work with drug-dependent babies, a person has to be a consistent volunteer for a year and go through additional training to understand the babies, their treatment needs, addiction and how to interact with mothers.

Since making all of the changes, Bagwell said babies at Nationwide Children’s now have an average length of stay of 21 days compared to 59 days in 2008.

That accomplishment has come despite the number of babies born drug-dependent in Ohio increased more than three times, to 1,691 during the same period.

Staggering growth

While about 1 percent of Ohio babies were born drug-dependent between 2009 and 2013 — up from less than half a percent from 2005-2009 — several counties in southern Ohio are much higher; 8 percent in Scioto County, 7 percent in Lawrence County and 6 percent in Pike County.

In Coshocton County, less than half a percent of babies were born drug dependent from 2009 to 2013.

Sandy Dorsey, a registered nurse in Genesis Hospital’s intermediate care nursery in Zanesville, said the hospital has seen an increase in the number of babies born addicted to opioids in recent years. As neonatal abstinence syndrome, or NAS, has become more prevalent, Genesis has increased its efforts in training employees to look for signs.

“We just didn’t know as much about NAS back then,” said Dorsey, who has worked at Genesis for 16 years.

Each patient receives a urine test. Once medical workers determine the drug or drugs to which the mother is addicted, she is referred to an outpatient clinic in her area.

Babies are monitored at Genesis and given what is called a Finnegan score, which measures withdrawal symptoms such as jitters, fussiness, poor feeding habits or sweating. The babies are then given appropriate medication to combat withdrawal.

Ohio isn’t alone. Nationally, admissions for neonatal abstinence syndrome nearly quadrupled between 2004 and 2013 with rates the highest in a region encompassing Tennessee, Mississippi, Alabama, and Kentucky, according to a USA Today report.

The driving force behind the increase has been abuse of prescription pills and heroin. In Ohio, there has been an 841 percent increase in the number of delivering mothers diagnosed with an opioid dependency, according to the Ohio Department of Health.

Some doctors said the growing awareness of neonatal abstinence syndrome — the first week of July was the first ever NAS awareness week in Ohio — contributes to the increased numbers. However, Bagwell contends the data doesn’t show the full scope of the problem.

Sometimes use, especially of prescription medication, is hidden and symptoms of withdrawal in the baby could be delayed and happen at home. In those cases, the babies potentially would be misdiagnosed with colic or as being irritable.

“We’re nowhere near knowing the extent of the problem because we’re not identifying it all,” Bagwell said.

Reaching moms

As with the overall opiate epidemic, access to treatment continues to be one of the biggest challenges in pushing the trend down, said Dr. Mark Hurst, medical director for the Ohio Department of Mental Health and Addiction Services. That problem is national — less than 2,000 of the 11,000 treatment facilities listed in the U.S. Substance Abuse and Mental Health Services Administration include services for pregnant women.

Ohio is trying to address that with its Maternal Opiate Medical Support, or MOMS, Project, announced in August 2013. The three-year pilot is supported with $4.2 million in state money for four different regional projects to engage 300 pregnant women.

The project connects women who are addicted with medication assisted treatment, either methadone or buprenorphine, along with counseling and other supports, such as housing.

While using medication in drug treatment is controversial — some view it as trading one drug for another — Hurst said it’s safer for pregnant women and their babies.

“The most important thing is the mom to be in treatment and not withdrawal,” he said.

The medications help ease withdrawal symptoms that are distressful to both the pregnant women and the unborn baby. The affects of withdrawal could lead to miscarriage.

When mothers are in treatment, Kennedy and Bagwell said it helps them because they know what the baby has been exposed to.

“The goal is to get moms off the streets using street drugs or abusing prescription drugs and getting them into a treatment program, whether it’s methadone treatment for the moms or Suboxone for the moms, so that they get prenatal care. When you get prenatal care you have better outcomes,” Bagwell said.

And, if all goes according to plan, the mother remains in recovery and the child has a healthier start at home, too, by remaining with family instead of in the foster care system, Hurst said.

Preliminary data from the MOMS project indicates that, as of November, 82 percent of the pregnant mothers had adhered to their medication assisted treatment plan while 18 percent had tested positive for illicit opioids.

While the MOMS and the Perinatal Quality Collaborative protocol projects aim to address the effects of addiction, the answer to truly reducing numbers of babies born drug dependent lies in prevention, said Brad DeCamp, chief of the State Opioid Treatment Authority.

“We really have to try to provide as much prevention . . . as possible,” DeCamp said.

And that kind of effort takes a community to recognize there is a problem, to talk with their children and find ways to help, which can be just properly disposing of old medication, Hurst said.

For Pickworth-Campbell, it’s rocking the babies, despite the tears she sometimes sheds.

“What keeps me coming back? Because I love them. Because they need comforted,” she said.

jison@Gannett.com

Twitter: @JonaIson

Want to volunteer?

For more information about volunteer opportunities at Nationwide Children’s Hospital, go online to www.nationwidechildrens.org/volunteering or call volunteer services at (614) 722-3635. Anyone interested in becoming a volunteer neonatal abstinence syndrome specialist will need to volunteer at the hospital for at least one year before being considered.