Two years ago, Sarasota Memorial Hospital made a number of changes to how it treats babies born with neonatal abstinence syndrome (NAS), which occurs when a newborn experiences withdrawal symptoms after being exposed to drugs like opiates while in the womb. According to new data, the changes have resulted in infants born with NAS needing fewer drugs and staying in the hospital for less time. That's good news, says Dr. Sara Seng, a pharmacist who works with the hospital's neonatal intensive care unit and pediatrics department.
"Any time we can use less medication, it's definitely beneficial," says Seng.
Statewide, 7,329 newborns were born with NAS between 2014 and 2018. Sarasota and Manatee counties have some of the state's highest rates of births with the syndrome. Both have been hit hard by the proliferation of opioids and heroin, recording overdose rates above the state average in 2016 and 2017. Those numbers began to decline in 2018, but have since begun to rise again. Approximately 100 newborns exposed to drugs while in the womb are born at Sarasota Memorial alone each year. Forty-three newborns in Sarasota County suffered from NAS in 2018, and another 65 were born with the condition in Manatee County.
Newborns with NAS are often given morphine to ease their symptoms. The hospital is still using morphine, but has raised its threshold for when it prescribes the drug, lowered its dosages and changed the secondary drugs it prescribes to help babies—replacing phenobarbital with clonidine in many cases, which lessens the amount of drugs a baby might have to take after being discharged.
As a result, the percentage of substance-exposed babies who receive drugs in the hospital dropped from 51.2 percent in 2017 to 29 percent in 2019, according to data compiled by Seng and Elizabeth Fernandez, a doctor of pharmacy candidate at the Lake Erie College of Osteopathic Medicine in Bradenton.
In addition to changing its prescription guidelines, the hospital has also more greatly encouraged breastfeeding and skin-to-skin contact between newborns with NAS and their mothers. "We're emphasizing mom being at the bedside," says Seng. "How important it is when mom is there to hold them and comfort them and we can sometimes get away with not using medication."
The hospital has also made a more concerted effort to connect mothers with assistance after they are discharged, helping them get in touch with nonprofits that assist new parents, like the Healthy Start Coalition of Sarasota County. The hospital is also participating in the Florida Perinatal Quality Collaborative at the University of South Florida, which has helped establish best practices for dealing with NAS for hospitals around the state.
The Addiction Support and Pregnancy coalition, meanwhile, has also brought together physicians, nurses, methadone clinics and health nonprofits that work with addicted mothers. The goal is to pool resources to prevent mothers with substance abuse problems from falling through the cracks.
Overall, this mix of programs has reduced how long substance-exposed newborns have to stay in the hospital. In 2017, the average length of stay was 13.4 days, nearly two full weeks. In 2019, that number had decreased to 8.3 days. Seng says reducing hospital stays allows babies to be home with their families sooner and reduces the burden on the health care system.
The long-term effects of NAS remain unclear. Some studies have found that it leads to developmental delays. But it can be difficult to single out the syndrome's effects on someone later in life. Still, Seng says, reducing the use of drugs like morphine improves a child's odds. "We want to preserve their brains as much as possible," she explains, "to give them the best chance for good neurological development."
Seng says the cumulative effort of doctors, nurses and other health professionals is making a difference. "Our experience here in the unit, seeing these babies day in and day out, this decreasing length of stay is real," she says. "We think it's a big deal."