Swaddled in soft hospital blankets, Lexi is 2 weeks old and weighs 6 pounds. She鈥檚 been at in Providence, Rhode Island since she was born, and is experiencing symptoms of opioid withdrawal. Her mother took methadone to wean herself from heroin when she got pregnant, just as doctors advised. But now the hospital team has to wean newborn Lexi from the methadone.
As rates of opioid addiction have climbed in the U.S., the number of babies born with聽 has increased, too 鈥� from 2000 to 2012, according to the National Institute of Drug Abuse.
It can be a painful way to enter the world, abruptly cut off from the drug in the mother鈥檚 system. The baby is usually born with some level of circulating opioids. As drug levels decline in the first 72 hours, various withdrawal symptoms may appear 鈥� such as trembling, vomiting, diarrhea or seizures.
At some point, if symptoms mount in number or severity, doctors will begin giving medication to help ease them. The idea is to give the the baby just enough opioid to reduce their symptoms, and then then slowly, over days or weeks, decrease that dose to zero.
A doctor comes to check on Lexi and her mother, Carrie. To protect her family鈥檚 privacy, Carrie asked us not to use their last name.
鈥淪o, hi, Peanut!鈥� the doctor says to the baby. 鈥淎ny concerns?鈥� she asks Carrie.
鈥淐oming down has been catching up with her,鈥� says Carrie.
鈥淒o you feel like she鈥檚 jittery?鈥� the doctor asks.
鈥淪he didn鈥檛 want to be put down last night 鈥� like [she had] the shakes,鈥� Carrie says.
Lexi has neonatal abstinence syndrome, and has been getting methadone treatments for it. She is getting better 鈥� most babies do 鈥� but even with treatment, she鈥檚 had tremors, diarrhea, and she鈥檚 cried and cried. Her little arms and legs tighten up, her fingers and toes clenched. She鈥檚 been feverish, her mother says.
鈥淚 know what she鈥檚 feeling,鈥� Carrie says. 鈥淎nd that is the worst part.鈥�
Carrie was addicted to heroin herself and knows withdrawal is miserable. She鈥檚 been off heroin since she found out she was pregnant, she said, with help from methadone. It keeps a low level of opioid in her system so she doesn鈥檛 go into withdrawal, but it doesn鈥檛 get her high. For Carrie and thousands like her, methadone is a lifesaver 鈥� helping them quit a heroin or oxycodone or other opioid habit for good.
But getting pregnant posed a dilemma: If Carrie stopped taking opioids altogether, she risked relapse or miscarriage. Yet, if she continued to take any opioid 鈥� including methadone 鈥� there would be a 60 to 80 percent chance that her baby would be born with neonatal abstinence syndrome, the doctors told her.
鈥淚t鈥檚 hard to watch, as her mother,鈥� Carrie said, 鈥渂ecause you鈥檙e helpless and there鈥檚 really nothing you can do. You are a lot of the reason why she鈥檚 going through what she鈥檚 going through.鈥�
Babies going through withdrawal spend weeks 鈥� even months 鈥� in hospital nurseries like this one.
Cindy Robin, a registered nurse at Women and Infants Hospital in Providence, Rhode Island, helps newborns through symptoms of withdrawal. (Kristin Espeland Gourlay/RIPR)
鈥淭heir cry is very different,鈥� said Cindy Robin, a registered nurse at the Providence hospital, who has been caring for mothers and newborns for more than 30 years. 鈥淚t鈥檚 a more distressed cry,鈥� she said, 鈥渁nd it really pulls at your heartstrings to have to listen to them.鈥�
Robin said babies with mild symptoms of the withdrawal syndrome will sneeze and sniffle. They have trouble settling down. Babies who have a more severe case can have seizures and dangerously high fevers. Robin said nurses have to dim the lights, and swaddle the newborns tightly to help keep them calm.
鈥淭hey just need to be held in a nice, quiet spot,鈥� she said. 鈥淲e have nice quiet music playing, and try to keep them as comfortable as possible.鈥�
Nurses with special training check on the babies every couple of hours.
鈥淪o these are the things that we look for 鈥� and what we teach the parents,鈥� she said: 鈥淚s the baby crying excessively? Is it a high pitched cry? Is it just a continuous cry? How do they sleep after they eat?鈥�
Medication, which is gradually decreased, can help ease this constellation of symptoms.
鈥淭he American Academy of Pediatrics and others recommend an opioid for the babies, because you鈥檙e giving them back what they鈥檙e withdrawing from,鈥� said聽, a neonatologist and chief of newborn medicine at Tufts鈥� Medical Center. 鈥淢orphine and methadone are the two most common.鈥�
But Davis said no one鈥檚 really done the research to determine聽which drug works better for babies, and doctors are left to figure that out by trial and error, case by case. Though the Food and Drug Administration hasn鈥檛 officially approved morphine or methadone for use in newborns, doctors prescribe these drugs to the children anyway, in smaller doses than they give adults.
鈥淎s I spoke to people around the country, everyone would have their own approach and a very different way of treating these babies,鈥� Davis said. 鈥淎nd we thought that quite odd.鈥�
Their cry is very different. It鈥檚 a more distressed cry and it really pulls at your heartstrings.
So he and a colleague, Brown University developmental psychologist , have launched a major study to sort out what works best. The two are hoping to enroll 180 babies in their double-blind, randomized, controlled trial 鈥� no one will know which newborns are getting methadone, and which are getting morphine, for example, until the study鈥檚 end. And they鈥檙e taking the research further: No study yet has looked at the long-term effects of the drugs, so Davis and Lester will continue to follow-up with measures of cognitive and physical development until the children are 18 months old.
鈥淚t may be,鈥� Davis says, 鈥渢hat one agent is safer short-term, but when we look longer-term it may actually be more dangerous.鈥� Teasing out long-term effects of a drug isn鈥檛 easy, Lester says; many factors can influence a baby鈥檚 development.
鈥淚f you鈥檙e drug-exposed and you鈥檙e growing up in an inadequate environment 鈥� which may not be poverty, it may be inadequate parenting 鈥� that鈥檚 a double whammy,鈥� he says. 鈥淭hose are going to be your worst case scenarios.鈥�
Despite many remaining unknowns, doctors have consistently found that treatment with morphine or methadone enables most babies to get through withdrawal in about six to eight weeks.
鈥淚t can be heartbreaking,鈥� said Robin, who has helped shepherd many kids through dark days. 鈥淏ut at the end, it is also rewarding,鈥� she said, 鈥渂ecause you see them get better and you see them go home.鈥�
This story is the first聽in our four-part series, 鈥淭reating the Tiniest Opioid Patients,鈥澛燼 collaboration produced by Kaiser Health News, NPR and聽local NPR member stations.