Babies With Opioid Withdrawal Might Do Better Outside the ICU

Babies With Opioid Withdrawal Might Do Better Outside the ICU

(Reuters Health) – Newborns suffering from opioid withdrawal might have shorter hospital stays and less need for medications if they stay in a room with their mother instead of being sent to intensive care, a research review suggests.

Researchers examined data from six previously published studies with a total of 549 babies. Compared to opioid-exposed newborns treated in neonatal intensive care units (NICUs), infants who “roomed-in” with their mothers were 63% less likely to receive drugs like morphine or methadone for withdrawal symptoms, the study found.

With rooming-in, these babies also tended to leave the hospital about ten days sooner than infants treated in the NICU, a difference that might be explained by fewer complications or better quality care.

“Our findings support rooming-in as the standard of care for opioid-exposed newborns, suggesting that mothers should be viewed as the first-line treatment for these infants,” said study co-author Kanak Verma, a researcher at the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire.

Within days after delivery, babies exposed to opioids during pregnancy can develop neonatal abstinence syndrome, which can include increased muscle tone, tremors, sweating, vomiting, and diarrhea.

Amid a worsening national opioid crisis, a growing number of infants are being born addicted to these narcotics and suffering withdrawal symptoms. Between 1999 and 2013, the proportion of infants with neonatal abstinence syndrome surged from 1.5 in 1,000 to 6 in 1,000, researchers note online February 5 in JAMA Pediatrics.

Standard care for these babies often includes a stint in the NICU and medications to ease withdrawal symptoms. But the current findings offer fresh evidence that opioid-exposed babies – like other newborns – may benefit more from a mother’s touch than the exposure to bright lights and loud sounds in the NICU.

“We believe that room-in improves outcomes by optimizing early bonding and facilitating attachment between mother and infant,” Verma said by email. “Parents and caregivers have an opportunity to take a more active role in their infant’s care, allowing for increased skin-to-skin contact, breastfeeding and cuddling with their newborn.”

Babies appeared to have a higher likelihood of breastfeeding and better odds of being discharged home to live with their family after rooming-in than after a stay in the NICU, although few studies in the analysis examined this.

Three of the studies in the current analysis also suggested that the cost of care may be cheaper with rooming-in than with the NICU.

The study wasn’t a controlled experiment designed to prove whether or how rooming-in might directly improve outcomes or lower costs for treating opioid-exposed newborns.

Another drawback is that the smaller studies in the analysis used a variety of designs and measured different things, making it hard to measure the effects of rooming-in, the authors note.

While the studies add to the evidence that rooming-in may benefit babies, in the case of neonatal abstinence syndrome hospitals must ensure that the mothers are drug-free and able to care for infants before choosing this option instead of the NICU, said Joshua Brown, a researcher at the University of Florida College of Pharmacy in Gainesville who wasn’t involved in the study.

“No matter newborn status/health, rooming-in should be advocated to increase skin-to-skin time, breastfeeding and a loving environment,” Brown said by email. “However, the health and safety of a newborn have to be defended, and in the case of neonatal abstinence syndrome births, the mothers’ situation must be thoroughly vetted by hospital staff to ensure that the room environment is safe and nurturing and breast milk is free of opioids.”

SOURCE: http://bit.ly/2nFW6Pp

JAMA Pediatr 2018.

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