Page 10 - FOCUS December 2017

COVER STORY
don’t require intensive care, Christiana Care created a special unit called the Continuing Care Nursery that serves the special needs of infants who are experiencing withdrawal and their families. The unit has a quiet environment and single-family rooms. Parents are encouraged to stay with their infants as much as possible.
Christiana Care also has a volunteer Cuddlers program that helps to provide comfort and human contact for babies when the mother is not present.
Infants with NAS cared for in the Continuing Care Nursery stay at the hospital for 11 fewer days compared with infants with NAS who are treated in the NICU. Though it’s possible that the severity of infants’ medical complications in the NICU is partly responsible for their longer stays, Dr. Paul believes the calmer, family-centered environment of the Continuing Care Nursery is the causal factor.
When these infants are released from the hospital, they are no longer dependent on opioids, and their withdrawal symptoms have eased, but the illness is not over. They can display symptoms for months. Nurses from Christiana Care’s Visiting Nurse Association play a key role in helping both mother and baby stay on track.
Jennifer Velasco, BSN, RN, has been conducting home visits for 25 years. She said infants with NAS were once rare but now account for more than half of her cases.
“We offer a crucial service for these new moms,” Velasco said. “They’re not in the hospital anymore with eyes on them 24/7.”
Her colleague, Kathleen Brady, RN, said giving birth is often a major turning point for mothers who are addicted to opioids.
“They realize the seriousness of their condition and the need to have treatment,” Brady said. “They’re very motivated to care for their baby and do the right thing.”
Forming a mother-child bond is essential in the weeks and months after hospital discharge. The symptoms of NAS — especially irritability and difficulty focusing on parents — can make this bond more difficult to form. The nurses teach parents how to massage their infants and calm them with skin-to-skin contact. They also evaluate the safety of the home and the readiness of the parents.
If the child is gaining weight and appears healthy, two visits are often sufficient. Fortunately, the long-term effects of NAS do not appear to be as severe as with fetal alcohol syndrome.
Christiana Care’s Cuddlers program provides comfort and human contact for babies when family can’t be there.
Still, Dr. Paul said it’s unclear what the long-term effects of NAS might be, largely because it’s difficult to isolate the relative impact of opioids, other substance exposure and sociological risk factors after birth. A child’s environment growing up is likely more determinative of their lifelong health than the drug exposure in utero, he said.
Addressing these social and environmental, rather than medical, determinants of health will remain a major challenge.
“Our goal is to keep mothers off illicit drugs and to give them the framework and support they need while pregnant and beyond,” Dr. Zadzielski said. ●
10 • FOCUS DECEMBER 2017