Caregivers find new ways to ease infant withdrawal

As the opioid epidemic deepens its deadly grip on New Hampshire, hospitals are seeing an increase in the number of babies suffering because of it.Born in withdrawal, these infants suffer nausea, headaches, tremors, diarrhea and rashes. They often can't eat, sleep or relax.

They cry, inconsolably.

It's called neonatal abstinence syndrome, and it's the result of mothers using drugs during pregnancy.

"It's heartbreaking," said Barbara Pascoe, director of maternity, pediatrics and women's health at Concord Hospital. "They can't organize their feeding and breathing. They cry and they sound like they're in pain.

"They need a lot of nurturing and holding."

Pascoe and others at Concord Hospital have been exploring new kinds of therapy to soothe these little ones.

In the hospital's special-care nursery, NAS babies - and their parents - are offered harp music, aromatherapy and Reiki massage to comfort them. And there are signs that it's working.

Alice Kinsler is manager of the therapeutic arts program at Concord Hospital, where she's worked for 26 years. A Reiki practitioner, she remembers the first time she and a nurse used it on a crying baby boy born with NAS.

"Seeing this agitated, uncomfortable baby calm and settle under our hands was just extraordinary," she said.

Kinsler and Pascoe hatched the idea of trying alternative therapies with NAS babies about two years ago.

Kinsler was showing Pascoe a "reverie harp" she had made to use with patients. Rich and resonant, the harp is tuned to a pentatonic scale. And that means anyone can play it.

Pascoe thought it could help the NAS babies.

A few months later, Tena Ferenczhalmy joined the hospital staff as a neonatal nurse educator. She brings 25 years of neonatal nursing experience and a deep compassion for these particular babies - and moms.

They decided to try aromatherapy with NAS newborns, using bottles with cotton balls soaked in essential oils that parents can uncap around their babies.

Lavender can be calming and induce sleep; peppermint can ease nausea and headache; lemon is energizing; ginger can soothe gastrointestinal distress.

One day, Ferenczhalmy was holding a crying baby on her lap who couldn't be soothed. She tried lavender but he didn't respond at all; "it made him cry more."

Then she wafted peppermint. The baby "went from hyper-alert and crying to calm and sleeping within a few minutes," she said.

Pascoe said the inconsolable crying is the hardest part of caring for these babies. Newborns typically sleep 18 hours a day, she said. But NAS babies "don't sleep because they're crying."

"Withdrawing"

It's not accurate to call these newborns addicts, which is a behavioral term, the nurses said. "When you are addicted to something, you do anything to fulfill that addiction," Pascoe said.

"The babies cannot and will not do any of those things. But they are withdrawing from what their mother is addicted to."

Last year, 52 babies were born at Concord Hospital with NAS, a 28 percent increase over the prior year.

Ferenczhalmy said Boston hospitals are seeing a growing number of babies born to mothers addicted to more than one drug. But the NAS population here tends to be infants whose mothers were on opioid substitutes, such as methadone or Subutex (buprenorphine), she said.

She credits OB-GYN and primary care physicians in New Hampshire for recognizing addiction and getting patients into medication-assisted treatment during pregnancy.

Most mothers "don't want to put their babies at risk," she said. "The majority have their babies' best interest at heart."

But opioid substitutes, while safer, can also cause NAS, she said.

The symptoms usually don't appear for the first 24 to 48 hours after birth. So babies born to mothers who used opioids, even legally prescribed ones, are kept for observation for four to five days after birth.

And that gives the nursery staff "a little window," Pascoe said, to offer parents the education and support many need.

Support for parents

They teach about "purple crying" and shaken baby syndrome, telling parents it's okay to put babies down and walk away when nothing seems to soothe them. NAS babies are particularly at risk, Pascoe said, because of their constant crying.

There's always some level of guilt in mothers of babies born with NAS, Ferenczhalmy said. It's something she wishes the outside world could understand: "There's not a single person who's going to be harder on that mom than she is herself."

Instead of blame or shame, the nurses offer these moms understanding, support and advice. "Every time the nurse cares for the baby, it's a teachable moment," said Pascoe.

Sometimes, the only treatment that will soothe NAS babies is morphine. The hospital uses a formula compounded just for these newborns.

The infants are then gradually weaned off the medication "until they can manage without it," Pascoe said. The process typically lasts about two weeks, but sometimes can take months.

The severity of NAS doesn't appear related to the amount of drugs the mother used, the nurses said. Even a mother who took a legally prescribed painkiller for kidney pain or an injury during pregnancy can have a baby born with withdrawal symptoms.

But the good news, Pascoe said, is that studies show that, unlike babies born with fetal alcohol syndrome, NAS babies are not at greater risk for future physiological or behavioral problems.

"If they are withdrawn appropriately, they do fine," she said.

The hospital's post-partum support nurses will continue to help these families for a year. But Ferenczhalmy said there are a few cases a year when the nurses know they're sending babies to homes where the odds are stacked against them. "It's heart-wrenching," she said.

The Concord Hospital team has shared its work with these unconventional NAS therapies with other members of a Vermont-based regional collaborative, so the program may someday spread to other hospitals.

They know they're working in largely uncharted waters. But they're willing to try anything that helps these littlest victims of the drug epidemic.

"We want to utilize non-pharmacologic intervention and really focus on improving the outcome of our patients," Pascoe said. "If that means we don't have to use as much morphine with our babies: huge win."

The toughest part, Ferenczhalmy said, is "knowing no matter how hard you try, sometimes you can't comfort them."

But it also fuels the team's efforts to look for other therapies to try, she said.

"It's a work in progress," Pascoe agreed. "Every time we try something new, we have such positive results."

Last week, Kinsler brought in harpist Pam Tyrrell of Hooksett, a certified music practitioner, to play for a baby girl with NAS.

Tyrrell, who performs as DeLuna, played for the newborn and her mom, pouring what she called the "love of a grandmother" into her music.

And as she was playing, the baby began to smile and then to laugh, she said.

"It was just a very beautiful experience," she said. "I carry the memory of that, and it warms my heart."

swickham@unionleader.com - See more at: http://www.unionleader.com/article/20150426/NEWS12/150429358#sthash.PPgbZD0X.dpuf