In the new NICU, babies in bassinets cried in dark rooms as medical staff tried to console them, with little success. Each day, a new baby would join the echoing shrills: the distinct sound of newborns in opioid withdrawal. I heard their high-pitched cries, and saw their irritability, seizures, and fitful sleep.
Three years ago, I began working as an intern family medicine doctor in rural Wilkes-Barre, Pennsylvania at Geisinger Wyoming Valley Medical Center and quickly realized this NICU was different. Almost all of the tiny patients showed symptoms that became the signature for neonatal abstinence syndrome.
This unit generally admitted babies with relatively uncomplicated cases of opioid withdrawal. Babies who required more medical support received care at the main hospital in Danville, Pennsylvania, an hour’s drive away.
As a doctor working in the Appalachian foothills, I witnessed the effects of opioid addiction unfold first-hand. Wilkes-Barre, a community of Polish and Italian families dating back several generations, was located in eastern Pennsylvania’s Luzerne County. This county reported more than 20 overdose-related deaths in 2014. Three years later, that number had climbed to 300. When I stood in that unit surrounded by infants enduring opioid withdrawal, I was watching a town on the brink of a public health epidemic that has since swept the country.
Some mothers experimented with drugs. Some were prescribed opioids after an operation or procedure. The result for each infant was opioid exposure in utero. No matter the introduction, addiction was hard to break, and recovery and relapse were often interwoven. I remember a mother in her early 20s who took Subutex, a treatment for opioid addiction, during pregnancy. Obstetricians, nurses and myself were concerned about how best to treat this mother’s C-section delivery pain. What if she took opioid painkillers and relapsed? What if the Subutex wasn’t enough to ease the pain? After weighing the risks and talking to the mother, we all decided to continue her doses of Subutex and nothing more.
Each morning, we determined where each baby fell on the Finnegan scale used for patients experiencing withdrawal and then determined how much medication was needed to counteract it. We charted each baby’s health by listening to its cries, observing its irritability and tremors, and monitoring feeding habits. The days were long. Volunteers offered essential help consoling newborns while medical staff cared for other patients. These volunteers tried to provide comfort by rocking babies gently while being careful not to overstimulate them.
Some of the babies had family that visited but the majority during my month in the NICU were given up for adoption. I remember discussing the babies with a nurse who worked by my side. She said she wanted to adopt the NAS newborns, but there were too many to count. The nurses’ struggle soon resembled my own.
My happiest days in the NICU occurred when our patients were discharged. But as fast as one NAS baby left, another would take its place. The month I spent in the NICU taught me an important early lesson as a young doctor. Treating these babies required detaching, at least somewhat, from my feelings.
In Wilkes-Barre, the numbers of NAS babies continues to rise – it was up 15 percent this year from 2014 numbers, according to Edward Everett, director of the Center for Prenatal Pediatrics of Geisinger Health System.
“It is not just about the babies withdrawing, but the families [they come from]” Everett said.
More needs to be done to combat the opioid epidemic, which continues to affect our most vulnerable. And as for me, years later, every time I consider prescribing opioids, and juggle with the dilemma of how to treat pain without causing future addiction, I hear those babies cry.