Two years ago, Colorado babies born addicted to opioids often were given doses of methadone or morphine and, on average, stayed in the hospital for 17 days as nurses weaned them off the drugs.
Now, the average hospital stay for a newborn going through opioid withdrawal has dropped to 6.5 days. And instead of treating those infants with regular doses of synthetic opioids or painkillers and admitting them to the neonatal intensive care unit, Colorado hospitals have moved toward a new care protocol that includes decreased use of pharmaceuticals and keeping babies close to their families.
As the opioid crisis hit across the country, and the numbers of babies born addicted to drugs skyrocketed, many hospitals developed treatment plans that involved scheduled doses of methadone or morphine that decreased over several days or weeks. “People started thinking maybe that is not the most appropriate way to do this,” said Dr. Danielle Smith, a neonatologist at the University of Colorado School of Medicine, noting that the treatment prolonged hospital stays as well as the babies’ exposure to drugs.
The results of a two-year collaboration among 20 hospitals in Colorado and Wyoming were shared this week at a conference focused on substance-exposed babies. The project — called the Colorado Hospital Substance Exposed Newborns Collaborative — has collected data on 650 infants born with drugs in their systems from 2017-19.
That number represents about half of babies born in Colorado in the two-year period who suffered from withdrawal, Smith said. Withdrawal in babies causes fussiness and inconsolable crying, trouble falling asleep and difficulty eating, as well as tremors and sometimes vomiting.
As part of the new treatment protocol, nurses and doctors are relying not just on newborn drug tests or a long-used scoring system called the Finnegan screen to determine whether babies are going through withdrawal. Instead, they’ve adopted a simpler test: Eat, Sleep, Console.
A newborn suffering from opioid withdrawal likely will have trouble drinking an ounce of milk at a time or sleeping for a full hour. And babies going through withdrawal are difficult to console, and still cry after 10 minutes of soothing, rocking and cuddling.
Nurses and doctors are pushing skin-to-skin cuddling, rooming with mom instead of the nursery, and drugs only when needed to soothe an infant instead of a standard dosing schedule, as in the past. And the results have been dramatic.
The percentage of Colorado babies who have been given drugs to get through withdrawals has dropped to 9% from 68% in the first two years of the collaborative.
A group of pediatricians, neonatologists, nurses, child welfare caseworkers and others met in Aurora to learn about the hospital collaborative, as well as a new initiative by the state child welfare department to make sure new mothers and babies exposed to drugs in utero don’t leave the hospital without a safety plan.
As the hospital collaborative grows, its leaders are hoping to increase the number of moms who breastfeed (if they are no longer using illegal drugs), and do a better job connecting them to pediatricians, drug treatment and mental health counseling, Smith said. The collaborative formed in 2017 and studied Massachusetts-based research that focused on better care and less pharmaceutical treatment for newborns. Its steering committee operates through the Colorado Attorney General’s Office’s substance abuse task force.
The collaborative, along with changes in child welfare policy, have made Colorado one of the leaders in the nation for treating substance-exposed babies, health officials and child advocates said. “The birth of a child is stressful for everyone, especially families impacted by substance use,” said Jade Woodard, executive director of Illuminate Colorado, a nonprofit that works to prevent child abuse and is part of the collaborative’s steering committee. “We are proud to keep building supports and bringing people together to strengthen families.”
In Colorado, county child welfare departments have started working more closely with local hospitals to make sure babies born with drugs in their systems and their families are receiving services, including in-home nurse visits, drug treatment or parenting classes.
Federal law passed in 2016 soon will require states to report how many newborns are born with drug exposure and whether hospital staff or child welfare caseworkers developed a safety plan. A plan to collect that data and make sure babies don’t leave the hospital without a safety checklist — which could include drug treatment for the mom, a daycare plan and a checkup schedule with a pediatrician — was piloted by Larimer County child welfare and Poudre Valley Hospital.
It rolls out to the rest of the state’s hospitals this year, said Suzy Morris, the substance-exposed newborn specialist for the Colorado Department of Human Services, which includes the child welfare division.
Under Colorado law, a positive test for illegal drugs in a newborn baby — through urine, meconium (stool from matter ingested in utero) or umbilical cord — is considered child abuse. Hospital staff are required to report it to their county child welfare officials.
A decade ago, if a baby was born to a mother who used methamphetamine, “it would have been automatic removal at the hospital,” meaning the infant would go into foster care, said Lucinda Connelly, the state’s child protection manager. Today, though, Colorado has more resources for what child welfare officials call “differential response” — offering community services, including counseling, treatment and parenting skills, that are intended to keep a family together.
County child welfare workers are required to review each referral from hospital staff about an opioid-addicted baby and decide whether to intervene. The intervention could range from helping create a safety plan for the baby to a foster care placement.
Under the new child welfare requirements, a caseworker will have to create a safety plan for drug-exposed babies unless one was already created by a hospital employee. In Larimer County, the “case conferences” to determine what is best for newborns are happening at the hospital, said Angela Mead, deputy division manager with the Larimer County Department of Human Services.
Nurses and doctors want to participate in those conversations because they want to make sure newborns they have cared for will be OK after they leave the hospital, she said. Mead asked how many of the medical professionals and caseworkers at the Aurora event had seen a baby in withdrawal. Dozens raised their hands.
“It’s traumatizing,” she said. “It’s hard to see.”
Still, the focus in child welfare is on keeping babies with their families, when possible. “These babies need their mommas,” Mead said, “and their mommas need to know what they need.”