In 2014, more than 600 infants in Indiana were born with neonatal abstinence syndrome, a condition that develops when a mother struggles with opioid dependence during pregnancy. A new study at Indiana University School of Medicine hopes to help those mothers and babies get the treatment and resources they need.
“We’ve seen an incredible increase in babies with neonatal abstinence syndrome across the country in the last several years,” said Scott Denne, MD, with the IU School of Medicine Department of Pediatrics. “It’s a significant problem.”
The CARE Plus program is a two-year project funded in part by the Richard M. Fairbanks Foundation. The project is led by several doctors and researchers within IU School of Medicine, including Dr. Denne. When a woman has her baby, a therapist and community health worker spend time with mothers in the hospital to teach them how to properly care for themselves and their baby while the baby is still being treated in the neonatal intensive care unit. Newborns with neonatal abstinence syndrome show several symptoms, such as not eating, sleeping or breathing properly. They also have rigid muscles and their nervous system may not regulate the rest of their body the way it should.
“The fetus was exposed to opioids in utero and they have developed a tolerance for the opioids,” said Dr. Denne. “Once the babies are born, there is this cycle of withdrawal. We provide an amount of opioid, usually morphine, and slowly ween them off the medication.”
Dr. Denne says this process usually takes two to four weeks before mom and baby can go home, but that’s when they often face a new set of challenges.
“That transition has been a huge problem for these moms because in some ways they’re part of a care system and they’re part of a support system that goes through their pregnancy and nursery experience,” said Dr. Denne. “After that, all of a sudden they have to find different caregivers, there are many treatment programs that don’t really accommodate a mother and baby pair and just having support through that time of having a new baby can be difficult.”
The CARE Plus program hopes to help make that transition a little easier through the community health worker, who can provide resources, tools and interventions for mom, whether it’s helping them learn to care for their new baby or navigate challenges with health care, housing, food or other social services.
“We have community health workers who are lay workers who are actually the ones providing the care and coaching to our women, fathers and other caregivers,” said Debra Litzelman, MD, a professor of medicine with IU School of Medicine and the Regenstrief Institute. “They do home visits or they can meet people at their OB visits, their post-partum visits, at the laundromat, one of the food fairs, wherever they want. They’re really out and about in the community.”
Indiana ranks among the highest in the country for infant deaths, and Dr. Litzelman says babies with neonatal abstinence syndrome may be at a higher-risk of dying before their first birthday. The team wants to learn whether focusing on providing resources to mothers and caregivers can change that.
“If you only focus on the addiction and say, ‘oh, I’m here, I’m your addiction coach,’ it’s not going to work,” said Dr. Litzelman, “so these coaches are identifying what they need help with, like housing, depression, food, diapers or other life stressors that might be contributing to use of drugs.”
The team plans to check in on the babies after one year to see the effects of the program. Dr. Denne says through this study, they hope to find ways to decrease opioid dependence in Indiana and across the country while helping babies with neonatal abstinence syndrome live long, healthy lives.
“There’s very limited data on the developmental outcomes of babies that have been exposed to opioids,” said Dr. Denne. “One of our goals is to follow these babies and do pretty sophisticated developmental testing so we can begin to answer those questions and find out ‘what does it mean for these babies and do these interventions help?’”
Learn more about the CARE Plus program at IU School of Medicine.