How the IWK became a leader in helping newborns cope with drug withdrawal

The high-pitched cries and trembling limbs of newborns in the throes of drug withdrawal can no longer be heard or seen in the IWK Health Centre's neonatal intensive care unit in Halifax.

Once in a brightly lit room filled with beeping machines, these babies have since been moved into private rooms with their parents where they can benefit from reduced noise, dimmed lights and more precious skin-to-skin time.

The change, which was gradually introduced starting in 2016, has made the Halifax women's and children's hospital a leader in treatment for babies going through withdrawal, said Dr. Michael Narvey, chair of the fetus and newborn committee at the Canadian Pediatric Society.  

"We should all learn from what they're doing," said Narvey. "These infants are very irritable, and their nervous systems — I've described to other people that it's like they're on fire."

In Nova Scotia, most babies that are going through withdrawal have been exposed to opioids. The majority go through withdrawal from methadone — a legal, synthetic opioid that's used to treat addiction to illicit narcotics.

Infants going through withdrawal can experience a range of symptoms, from general irritability to severe seizures. Some of those seizures can be so intense they can cause brain damage and even death. 

And yet, almost 80 per cent of babies going through withdrawal at the IWK last year no longer needed medication to help them cope with their symptoms.

• Newborns with opioid withdrawal do better cared for by mom, versus stay in intensive care

As recently as 2015, all of those babies would have been given drugs, said Cynthia Mann, a clinical nurse specialist and operations manager on the IWK's family newborn care unit.   

Keeping mothers and babies together plays a huge part in that reduction.

"All the noises are new, all the lights are new, everything is overwhelming. And so then if you take a baby that is potentially experiencing withdrawal, all of that would be more intense," said Mann. 

"So by keeping them close to their mother, they've got that familiarity of being inside and it just soothes them, it decreases their experience of pain, it decreases their experience of stress."

When babies were kept in the intensive care unit, they weren't getting as much valuable skin-to-skin time because parents would have to leave the unit to do things like sleep and eat. 

Mann said parents have been excited by the changes. 

"They have been so overwhelmingly pleased," she said. "They see such a difference in their babies, it's such a difference of environment for them, they feel so much more at ease and able to take care of their babies."

Research shows that skin-to-skin contact with parents as well as placing infants in a controlled, quiet environment have a huge impact on recovery, said Narvey. 

"These are the sorts of interventions we really need to be pursuing if we don't want to have to always leap to medication," he said. 

Medications commonly used for infants going through withdrawal include morphine and phenobarbital, which Narvey said can affect breathing and alertness.

"So there are side effect profiles that we need to consider when we're treating infants," he said.  

Generally, babies given drugs to help with their withdrawal symptoms also have to spend a greater amount of time in hospital as they are gradually weaned off their medication — a process that can take up to three weeks.

By comparison, Narvey said babies recovering without medication are generally out of hospital in five to seven days.

In 2015, a total of 57 women on methadone gave birth in Nova Scotia. That number rose to 58 the following year, and increased again to 66 in 2017, according to the Nova Scotia Atlee Perinatal Database, a provincial system now housed and managed at the IWK. 

The numbers for 2018 have not been compiled yet. 

While newborns in Nova Scotia most commonly go into withdrawal from methadone, Mann said she and her co-workers have also witnessed babies withdrawing from a range of street drugs to antidepressants. 

Despite what people may think, not all mothers who give birth to children in withdrawal are addicted to drugs, said Mann.  

"We see women of all sorts and ... all kinds of different health conditions, all kinds of different situations, that their babies are at risk of withdrawal."

The IWK's approach to caring for these newborns has not only impacted parents and their babies, but hospital staff as well.

"I think some people picture this population of parents being maybe a little more challenging," said Mann. 

"And I think our staff, our nurses in particular, have really bonded and connected and developed a lot of compassion and empathy as they watch these parents be so caring and nurturing to their babies."