Pubdate: Sat, 11 Jul 2015
Source: News-Journal (Mansfield, OH)
Copyright: 2015 News-Journal.
Author: Jona Ison


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

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 Richland County, nearly 1 percent of babies were born drug
dependent from 2009 to 2013.

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.

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

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.
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