Vol. 6 Issue 6
Helping Babies Battle Addiction
Through a unique program, nurses at Mt. Washington Pediatric Hospital care for newborns addicted to drugs
When Mt. Washington Pediatric Hospital, Baltimore, opened in 1922 as Happy Hills Convalescent Home for Children with the mission to care for youngsters with special needs, no one could anticipate how those needs would change over the years.
Children convalescing from a variety of illnesses, as well as those hospitalized for long-term care comprised many of the patients in 1922. Today, among a variety of programs, Mt. Washington Pediatric Hospital, a new modern sub-acute care facility also cares for newborns suffering the effects of drug addiction.
An integral part of the University of Maryland Medical System, Mt. Washington also shares a strong clinical relationship with Johns Hopkins Hospital and focuses on transitioning patients, birth through 21 years old, from the acute-care setting to home, school and back into their community.
As the drug addiction problem in this country grows, those most innocently affected are babies in utero born to opiate- addicted mothers. These infants can be full term or premature, and the process of drug withdrawal for the small newcomer can be a sobering traumatic experience.
Withdrawal symptoms often begin within 24 hours of birth and continue throughout the weaning process. "While these babies can be very challenging to care for, it is so rewarding to see the outcome when weaning is accomplished," said Michelle Jacobs, RN,C.
These infants are placed on a clinical pathway upon admission. Most arrive on medications such as phenobarbital to control hyperactivity, irritability and seizures; paregoric to decrease gastrointestinal tract motility and peristalsis; and/or chlorpromazine to control vomiting and for its sedative effect. The infant is regularly assessed according to the Finnegan Score, a tool that determines the severity of the withdrawal, and are weaned as clinically indicated.
The symptoms of infant drug withdrawal may include excessive and/or high-pitched crying, disturbance with sleep, jitteriness, clonus, tremors, increased muscle tone, and excoriation of the chin, knees, cheeks, elbows, toes or nose. Symptoms also include myoclonic jerks, seizures, excessive sweating, fever, frequent yawning, and mottling of the chest, trunk, arms or legs. Nasal stuffiness, sneezing, nasal flaring, increased respiratory rate, excessive sucking, poor feeding, vomiting and diarrhea also may be observed.
Nursing staff serve a pivotal role; and the care they provide is a critical link to the recovery of an infant withdrawing from addiction. Nurses acquire a tremendous sense of satisfaction as they clearly observe first-hand the infant's progress.
"Years ago these babies were among those in the nurseries who were merely labeled as fussy babies," said Linda Thornton, MSN, nursing education specialist. These babies went home and were often thought to just have colic. Eventually, the infant became weaned after enduring an extremely painful process that it could not communicate, and which could have been eased with medical intervention.
In the care of these special infants, the nursing assessment includes the effectiveness of medication therapy and weaning, a nutritional assessment to ensure proper weight gain, and assessment of skin integrity. Control of the environment is a very important factor, and stimulation must be minimized because of the infant's inability to regulate these stimuli.
Calming and soothing techniques are essential to the recovery process and include dimmed lights, soft and soothing music, infant massage, swaddling, rocking, traffic control and quiet rooms away from noises such as clinical monitors and pager system speakers. The nurse is essential in the education of the family and/or caregivers, and in addressing their fears and concerns regarding care of the infant post drug withdrawal.
Dorothy Kennedy, nursing technician, relates how difficult it is to see these tiny little ones go through so much, but could not see herself being anywhere else. "I love these babies; it makes me feel so good that I am really able to help," said Kennedy.
"Caring for infants enduring drug withdrawal can be very challenging, but our nursing staff will tell you it is a labor of love," said Monica Atkinson, RN, nurse manager.
A Team Effort
A dedicated interdisciplinary team demonstrates expertise and compassion in helping each child realize full potential, while also educating families in their care.
Mt. Washington Pediatric Hospital offers a variety of specialty inpatient and outpatient programs serving a medically fragile population, who are often transitioning from ICUs with post debilitating illness or trauma. Specialized care is also provided for children who undergo limb-lengthening procedures, are diabetics, ventilator patients and children with chronic lung disease such as cystic fibrosis. The average length of stay is 26 days, which enables clinical staff to really get to know the patient and family and to address their needs.
Expert and nationally recognized medical care guides the infant through the transition process. Many of these patients and their families have complex social needs that are addressed by nurse case managers and social workers. Respiratory therapists provide clinical interventions for acute and chronic medical conditions, and rehabilitation staff helps each child achieve his optimal level of functional independence. The clinical support services from pharmacy, laboratory, radiology and psychology compliment the continuum of care. Families are encouraged to be with their child throughout hospitalization, visiting at any time or spending the night.
Additionally, the team is collaborating on research that may help these children recover sooner. Actively underway within the neonatal abstinence program is an FDA-approved clinical trial evaluating the effects of the use of the anti-hypertensive drug clonidine in improving the narcotic withdrawal process and decreasing the length of stay for babies withdrawing from drugs.
In addition to research in the neonatal abstinence program, there are several special programs at Mt. Washington Pediatric Hospital. Among them is the Center for Pediatric and Adolescent Rehabilitation, the Center for Pediatric and Neonatal Transitional Care, the day treatment programs for feeding disorders, and rehabilitation and psychiatry all helping to get children back to health and back into their homes and community.
Sharon Kelley is vice president, patient care services & chief nurse executive at Mt. Washington Pediatric Hospital, Baltimore. She can be reached at firstname.lastname@example.org.