Photo: PRHC Neonatal Intensive Care Unit
Peterborough Regional Health Centre has one of the most progressive approaches in the country for treating an increasing number of babies born dependent on opioids and their mothers.
Dr. Hardy Brown has specialized in looking after babies for 8 years. The paediatrician says she first started noticing an increase in the numbers of babies born dependent on opioids in 2012. “We were seeing more of these cases and what we saw was significant stress on the baby and the mother.” She says they recognized they could do better for these families so they started developing the Neonatal Abstinence Clinic (NAS) at Peterborough Regional Health Centre. It opened in January 2014.
NAS is a group of problems that occur in newborns who were exposed to addictive opiate drugs while in the mother’s womb. A baby can then go through drug withdrawal after birth. Opiates are a variety of drugs ranging from legal drugs such as fentanyl, codeine, and morphine to illegal drugs such as heroin and opium.
Canadians take more prescription opioids than almost any country in the world. The number of opioid-related deaths in Ontario has surpassed the number of drivers killed in motor-vehicle accidents annually.
Dr. Hardy Brown says most of the women they are seeing at the clinic have been prescribed opiates.
According to stats provided by the hospital there were 20 babies born dependent on opioids at PRHC in 2012/13. That’s 12.8 per 1000 live births. The provincial average is 4.29 per 1000 live births. That number had jumped to almost 30 babies born dependent in 2014/2015 in Peterborough or 17.8 per live births.
By comparison St Josephs Hospital in Hamilton had about 40 babies born dependent in 2012.
Some symptoms of withdrawal in babies may include, tremors, excessive crying, high pitched crying, sleep problems and seizures.
The goal of the NAS clinic is to reduce the stress. They work to establish a connection with the family, educate and empower mothers and build trust. “Your health is only as good as how much you trust your caregivers” says Dr. Hardy Brown. The focus is on supporting families, decreasing shame and increasing participation she says. The team includes another paediatrician, an RN and a Social Worker.
Staff recognized early on that it was important to keep mom and baby together. It’s a new trend called “rooming in.” “Now mothers and babies are cared for in the same room from birth to discharge” She says they’ve seen less need for medication, less symptoms of withdrawal and the satisfaction of the mom’s goes up.
Care starts from the moment mom is admitted to hospital. The environment is kept quiet and dim and staff encourage active maternal participation. Once the baby is born, he/she is assessed using the Finnegan Scale. It’s meant to help quantify the extent of NAS and help chart a withdrawal and treatment plan for the baby. At PRHC the family is invited to be actively involved in the scoring. “We’ve found it really beneficial.” says Dr. Hardy Brown. “We have the eye’s that know the baby best, the mother” The scale assesses things like central nervous system disturbances, respiratory disturbances and gastrointestinal problems the baby might be experiencing.
The program is modelled after the Fir Square program at BC Women’s Hospital. Fir Square Combined Care Unit was the first in Canada to care for women who use substances and their newborns exposed to substances in a single unit.
It’s proven to be successful. “We’re really proud we’ve been able to decrease the length of stay.” says Hardy Brown. In 2013/2014 the average stay was 14 days, by 2015/2016 it was down to 11.7 days. “Think about being home three more days with your baby in a home environment” she says.
But the care doesn’t end when mom and baby leave hospital. “We continue to see mom and baby to make sure growth, nutrition and development is in place”
And they work closely with community partners. “This endeavour has recognized the best healthcare spans the hospital, it involves a lot of community partners” Partners such as Fourcast Addiction Treatment Centres, Five Counties Children’s Services and Peterborough Public Health. “By having a therapeutic relationship we have found more are willing to connect with outside resources” according to Dr. Hardy Brown.
In the future they are working on what Dr. Hardy Brown calls a “solid wrap around model” She says there’s still some education to do around breast feeding, making moms aware it’s still ok to breastfeed. They are also looking at bringing is safes for moms who are on methadone to treat addition to opiates, so they don’t have to leave the hospital to get it. “It’s just another way we are working to keep moms and babies together”