The opioid epidemic rages on, and Indiana is one of the most highly affected states. Ruined lives and families and overdose deaths continue unabated. Regardless of what progress we might have made in this battle, we have a very long way to go.
There is a tragic aspect of this epidemic, rapidly increasing in prevalence, that does not garner as much public attention as other facets of the opioid problem. This affects the youngest, most vulnerable, and innocent: Babies of addicted pregnant women are born opioid-dependent and commonly experience Neonatal Abstinence Syndrome upon the abrupt discontinuation at birth of chronic fetal exposure to opioids.
Every 25 minutes in the United States, a baby is born suffering from opioid withdrawal. Twenty percent of babies born in Indiana test positive for opioids. The withdrawal can be severe and prolonged. Neonates with NAS might withdraw for weeks in the hospital’s neonatal intensive care unit treated with repeated doses of Methadone or morphine to wean them from their opioid dependence.
Each hospitalization costs on the average $70,000, with some costing over $200,000. Newborns often experience distressingly intense withdrawal, including inconsolable crying, hyperirritability, spasticity, seizures, tremors, fever, difficulty eating, excessive weight loss, dehydration, vomiting, diarrhea and difficulty breathing. The tragedy might continue into childhood, with increased risk for emotional, behavioral, developmental and visual problems.
But a new program available to hospitals can greatly reduce both the baby’s suffering and the length of hospitalization. The “Comfort Care” model uses three essential elements that compose the name of the nationally available program: Eat.Sleep.Console.
The program focuses on the baby’s function and comfort rather than on signs of withdrawal. Opioids are administered to the newborn only if absolutely necessary, rather than routinely. Actually, the traditional treatment with repeated dosing of opioids only prolongs the hospitalization.
The program focuses on maternal involvement in the care of the newborn while supporting the mother’s emotional, social and addiction problems. Infants are frequently assessed for withdrawal and functional status. Rooming-in with the infant is greatly encouraged, eliminating the NICU environment. Maternal education on these specialized approaches is essential. Hospital nursing and other personnel deliver care in a supportive, communicative, caring and non-judgmental manner, setting the stage for maternal success.
Generous feedings are initiated proactively and early. Another goal is to have the newborn sleep comfortably, encouraging natural sleep patterns. Arousal of the newborn by caregivers in response to restlessness is avoided. Consoling is maximized using specific positioning, swaddling, rocking, pacifiers and other techniques. Soft music and singing to the infant are employed. Minimization of environmental stimuli—including dimming lights, noise avoidance, slow and gentle handling, and bundling of exams, assessments and other necessary interventions—is critical.
I know all this is amazingly simple and common-sensible in concept, but using these techniques in a coordinated, consistent manner can make a big difference. Franciscan Health Indianapolis was the first Indiana hospital to implement this approach, in 2018. Hospital length of stays reduced from sometimes weeks to only five to seven days. Babies rarely need morphine. Hospitals across Indiana are now adopting this approach, but it is far from universal. The potential for cost savings to health plans, hospital systems and Medicaid is enormous and in the millions of dollars.
Is your hospital using this program?•
Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to firstname.lastname@example.org.
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