Urban medical centers nationwide are scrambling to expand neonatal intensive care units or to build separate facilities to accommodate a tide of opioid-exposed babies arriving from rural communities.
The result, many experts say, is an exercise in good intentions gone awry.
After their babies are moved, many new mothers, poor and still struggling with addiction, cannot find transportation or the resources to visit. Those who can travel find that some local charities decline to provide housing to addicts, as they do for other parents visiting sick children.
“I have women coming to appointments who say they slept in their car all weekend because they can’t afford to stay in a hotel,” said Dr. C. Brent Barton, an obstetrician-gynecologist at St. Joseph London, a hospital in London, Ky.
Moreover, a growing body of evidence suggests that what these babies need is what has been taken away: a mother.
Separating newborns in withdrawal can slow the infants’ recovery, studies show, and undermine an already fragile parenting relationship. When mothers are close at hand, infants in withdrawal require less medication and fewer costly days in intensive care.
“Mom is a powerful treatment,” said Dr. Matthew Grossman, a pediatric hospitalist at Yale-New Haven Children’s Hospital who has studied the care of opioid-dependent babies.
Jay’la Cy’anne was born with a head of raven hair and a dependence on buprenorphine. Ms. Clay took the drug under the supervision of Dr. Barton to help reduce her oxycodone cravings and keep her off illicit drugs.
“Dr. Barton saved my life, and he saved my baby’s life,” Ms. Clay said. She also used cocaine on occasion in the first trimester, she said, but quit with his encouragement.
After a few days of observation, Jay’la Cy’anne was transferred by ambulance from Baptist Health Richmond to the University of Kentucky Children’s Hospital, 25 miles away, for treatment.
Before being discharged, Ms. Clay was visited by an official from the state child-protective services office, who broke the unwelcome news that custody of the newborn would be given to her parents, the child’s grandparents. (Officials declined to comment specifically on the case.)
For months, Ms. Clay had stayed sober, expecting that she’d be allowed to take her baby home. Standing in the hospital corridor, her dark hair up in a loose ponytail, she said, “I’m torn up in my heart.”
Generally, treatment for drug-dependent babies is expensive and can go on for months. Nationally, hospitalization costs rose to $1.5 billion in 2012, from $732 million in 2009, according to researchers at Vanderbilt University.
These are largely low-income parents, and Medicaid covers an estimated 80 percent of the hospital charges.
Babies in serious withdrawal can’t eat, sleep or settle down. Their bodies can be unusually stiff: When they are picked up, their heads may not fall back. Sleep may be interrupted by full-body “startles.”
Even feeding a baby in withdrawal can be challenging. “You give them a bottle, and they are frantic,” said Chandra Wells, a transport nurse based out of the University of Kentucky Children’s Hospital. “They can’t form a tight suck.”
The standard treatment is to drip tiny doses of morphine into the mouth with a syringe to make the newborn comfortable enough to eat and sleep. Then, over two to 12 weeks, the infant is weaned off morphine.
But community hospitals in rural areas rarely have neonatal intensive care units in which staff can administer morphine. So, after a brief period of observation, infants in withdrawal are transferred to more sophisticated facilities.
The transport team that delivers opioid-dependent babies to Kentucky Children’s Hospital is called the Kentucky Kids Crew. It is made up of two nurses in royal blue uniforms and an emergency medical technician, who drives an ambulance specially outfitted with an incubator.
The team picks up babies in severe withdrawal from 20 hospitals in rural towns across southern and eastern Kentucky. The squalling infants are at risk for seizures and hard to comfort.
By the time the team is on the scene, said Kelly Turner, a veteran transport nurse, beleaguered staff will meet it at the door and say, “We’re glad you’re here.”
The babies are taken to a multilevel pediatric hospital that has a Level 4 neonatal intensive care unit, the highest level of care. The unit has nine rooms of bassinets with swaddled babies hooked up to monitors that beep at all hours. The overhead lights are bright.
In 2015 and 2016, this unit was over capacity almost half the time. Nearly 60 babies in withdrawal had to be diverted to other hospitals, because there were infants with even more pressing needs, like life support or breathing assistance.
Ironically, a baby in withdrawal needs a quiet and dark environment without too many stimuli.
“Why are we putting kids in the NICU — a loud, bright room where their parents can’t stay?” Dr. Grossman asked.
A Different Model
Ms. Clay was able to visit her daughter six times during her 11-day stay at Kentucky Children’s. She fed her and dressed her up in the gifts she had brought: a pink gown, slippers with monkeys on them.
But she was not allowed to see the child unsupervised, because the child-protection order explicitly said one of her parents had to be present. Her mother, Tamara Clay, works 12-hour overnight shifts as a forklift operator, and her father was tied up caring for her toddler, Jakiah Rayne.