More babies being treated for withdrawal symptoms

Jonel Goings had a baby boy in 2014. She couldn’t keep him because she was addicted to an opioid medication.

Goings, the subject of an episode of A&E’s “Intervention,” was using Suboxone, the brand name of the narcotic buprenorphine, an opioid with pain-relieving properties used to treat addiction to prescription painkillers or heroin. However, buprenorphine can be addictive and used illicitly.

“I was just so messed up in my addiction,” Goings recalled of that time in her life. “I’d have to use to be able to get out of bed.”

Goings, 23, said she had started smoking pot and drinking in middle school. Her parents divorced when she was 10. She said her father basically abandoned her family and in the process traumatized her.

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Then, Goings became pregnant at 16. She stayed sober during that time, but her daughter’s father died just before her child was born.

She turned to drugs again.

“I didn’t know how to deal with it, and I sort of numbed my feelings out,” Goings said.

She left her daughter in the care her mother, Wendy, who was in recovery for her own methamphetamine addiction.

Goings described the years after her daughter was born as “hopeless.” She distanced herself from her family. She tried treatment. But Goings said the programs never combated her opioid withdrawal symptoms.

“I thought my life was never going to be happy,” she said.

Goings said she used Suboxone during her pregnancy, and her son was born exhibiting signs of withdrawal. She said her aunt and uncle are raising her son.

“I haven’t been in his life,” she added.

The Tribune has no medical information about the child, except that Goings’ mother, Wendy, noted the boy has had health issues. However, infants exhibiting signs of withdrawal after birth are often diagnosed with neonatal abstinence syndrome, or NAS.

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NAS symptoms occur after birth when the baby is no longer receiving a substance from the mother, according to Neonatal Nurse Practitioner Janine Hester of the Benefis Neonatal Intensive Care Unit.

Hester explained that “true NAS” is the withdrawal from opioids or another narcotic, along with anti-depressants and benzodiazepines (sleeping pills). The condition affects babies exposed to prescription medications and street drugs alike.

Hester noted the long-term effects of NAS are still being studied, but the condition is believed to cause cognitive and physical delays in some cases.

There are two aspects to treating NAS in any baby. First, non-pharmacological or drug-free measures are implemented to keep the baby comfortable. Hester said these measures are taken with any baby suspected to be at risk for NAS.

“NAS babies are more irritable, cranky or fussy, so they cry a lot,” she said.

The nurses use techniques performed for any fussy baby, such as swaddling and holding to boost physical contact. The staff also keeps the baby’s private NICU room dark to avoid over-stimulation, and nurses respond quickly to feeding cues.

The second part of treatment is pharmacological treatment, meaning the baby is given medication to combat withdrawal symptoms. The standard medication used for babies with NAS is a special formulation of morphine, an opioid, no matter what narcotic the baby received in utero.

The approach to treatment with morphine is standardized, with dosing based on the baby’s weight and symptoms. Symptoms are measured by a standardized scoring system.

The standard starting dose of morphine is very low, and Hester noted it has been lowered within the last year. The newborn receives morphine for 48 hours before a slow weaning process begins. The baby’s symptom score is recorded during the entire process.

“The key is the standardization among providers,” she said of treatment with morphine.

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Babies born at other medical facilities who reach the threshold for treatment with medication are transported to the NICU at Benefis, which is the only facility in the area equipped to treat infants with morphine.

Hester said Benefis Health System treated 15 infants with NAS in 2014, 15 in 2015 and 16 so far this year. Of those 53 infants, 66 percent were treated with morphine.

According to a Montana Department of Public Health and Human Services report, 432 infants were born with NAS from 2000 to 2013, based on medical coding information. The study says there was a steady increase from 2006 to 2012, and a substantial upturn between 2012 and 2013, that may be attributed in part to revised NAS diagnostic guidelines issued in 2012.

Most infants with NAS treated at Benefis are born full-term, Hester said, but noted that premature babies don’t manifest withdrawal symptoms in the same way.

According to Hester, withdrawal symptoms do not always appear right away, depending on the substance’s half-life and other factors. Symptoms can persist for 24 to 96 hours after birth, so babies deemed to be at-risk are monitored for four days.

Benefis has developed criteria that is applied on the labor and delivery floor to determine whether testing of the mother is necessary.

“It’s definitely a team effort,” Hester said of the treatment of NAS at Benefis.

The process involves social workers, case managers, medical staff and, when possible, the parents.

“Them being here with their baby is the best thing they can do,” Hester said. “I think every family wants to be here, but they can’t always.”

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That applies to parents with infants in the NICU for any reason.

“These mothers love their babies just like any mom loves their baby,” she added.

Handling NAS cases requires the team to maintain a non-judgmental attitude so families know the NICU is a safe space.

“If they don’t feel safe they won’t be here for treatment,” Hester said.

The staff has received additional education about addiction in general over the last few years, and ongoing education about NAS screening and treatment is a part of the process.

Quitting a substance “cold turkey” during pregnancy is not the solution to NAS. Hester pointed out that withdrawal is not the best option in utero, especially if the mother is taking methadone.

The March of Dimes posted the following advice on its website, “If you’re pregnant and taking opioids, don’t stop taking them until you talk to your health care provider. Stopping opioids too quickly can be harmful to you and your baby.”

Hester stressed the need for prenatal medical care for mothers using any medication or other substance during pregnancy. She said there are many reasons mothers do not seek medical care in general during pregnancy, and substance use is one of them.

That was the case for Goings, who said she feared the judgment of others during her pregnancy.

“If I was in my right mind nothing would have been like that,” she said. “I carry shame about it.”

“Sometimes this can be the moment that inspires mom to seek treatment,” Hester said.

Other times the child is placed in foster care upon release from the NICU.

“The goal is for baby to go to a safe, loving home,” Hester said.

Goings said she could not provide a safe home for her children after her son’s birth.

“I knew I couldn’t take care of my kids and I didn’t want to drag them through what I was going through,” she said.

Goings did not receive effective treatment until the A&E network sent her to the Sober Way Home facility in Prescott, Arizona, for the “Intervention” TV show. She, her mother and her daughter have moved away from their Browning home for a fresh start in Great Falls with the Family Promise shelter program to protect their recovery processes.

“It’s heaven compared to what we lived,” Wendy Goings said.

They founded an activist group, “The Silent Warriors Coalition,” to address the addiction-related issues plaguing their home.

Drug treatment courts in Montana and other states are one option for justice-involved pregnant women.

“Drug-free babies are a goal among treatment courts,” said District Judge Greg Pinski, who presides over the 8th Judicial District Adult Drug Treatment Court and Veterans Treatment Court.

Pinski explained that treatment court programs have the supervisory tools in place to help women maintain their sobriety during pregnancy.

According to a 2011 study of drug courts by Montana Supreme Court, 14 babies were born to drug court participants between May 2008 and October 2010. The study says 12 of those babies were born drug-free, representing a medical cost savings of up to $750,000 per child for needed medical before adulthood.

Taxpayer cost-savings are a hallmark of the treatment court programs, which provide treatment instead of incarceration, but effective treatment saves more than money.

“If you can achieve a drug-free birth, you’re giving the child a chance they wouldn’t otherwise have,” Pinski said. “Anytime you can preserve a family you have to preserve that, because a strong family equals successful lives.”

Pinski sees people with substance use disorders engaging in risky behaviors, which can lead to unplanned pregnancies.

“To a person not suffering from addiction, these issues can be hard to understand,” Pinski explained. “None of the tragic life circumstances that so often accompany addiction are enough to overcome it.”

That can include a health problems for an unborn child.

“I don’t think I’ve ever met anyone using drugs to intentionally hurt their unborn child,” he said.

Babies treated for NAS are usually fussy when they go home, Hester explained. The NICU staff work to educate parents and caregivers about the most effective ways to manage this challenge.

“The key is prepping parents on what to expect at home,” Hester noted.

It can be the beginning of challenges ahead.

NAS can lead to behavioral issues, learning disabilities and issues with attention span. Hester said the impact of NAS continues to be studied, “but we know there are lasting effects.”