For babies exposed to opioids in the womb, parents may be the best medicine - what is the best car alarm
The first thing you will notice is noise.
Continuously and relentlessly monitor the beeps and be ready to sound the car at any time
If the baby is in trouble, an alarm will be issued.
There is a smell of Shibuya in the air
Not clean, but reminiscent of the operating room (
There's one next door).
The ceiling lamp emits white fluorescence.
Half is off, but the bright light from the display will give out extra light.
Friday is noon, but it will be as bright as midnight.
There are 10 small beds on the fourth floor of Yale New Haven Children's Hospital, with 10 small babies in it, each with a band
Patches like aid stick to their bodies to continuously monitor health.
Between the two beds, the nurse crammed into the narrow aisle, stuffed with folding chairs and plastic incubator.
This space is one of the five spaces in the hospital's neonatal intensive care unit with the people and equipment needed to keep sick babies alive
Heart rate monitor, oxygen tank, IV bar for the drug.
Until recently, the Yale University's nicu NCR and hundreds across the country were considered places for newborns to withdraw from opioid drugs.
But now with the amount of drugs
Relying on the baby surge, doctors here and elsewhere are looking for better options.
"We really focus on getting these kids out of the NICU," says Yale pediatrician Matthew Grossman . ".
"We see our parents as the first line of treatment.
Nationwide, the proportion of infants withdrawing from opioid drugs has soared.
From 2000 to 2012, it grew by nearly 400%.
The numbers are bleak.
The United States is fighting drugs: Sales of prescription-only opioid painkillers have quadrupled from 1999 to 2010, and the number of excess deaths has quadrupled from 2000 to 2014.
When a pregnant woman uses an opioid, the drug is passed from the blood to the baby.
For example, infants may become dependent after contacting Vicodin, heroin or heroin in the womb.
At birth, the baby can experience a painful exit when the drug stops flowing --
Body trembling, intestinal problems, constantly crying.
This situation is known as neonatal abstinence syndrome (NAS ).
But Grossman says there is no clear consensus on how to take care of these struggling babies.
They are usually sent to the NICU for opioid treatment.
The drugs relieved the symptoms, but extended the use of "very effective and potentially dangerous drugs", he said.
At Yale, NAS babies spent weeks in the NICU
They still do so in many states. S. hospitals.
But in the past few years, Grossman and others have begun to question this approach to care.
Infants with opioid withdrawal may actually do better in their parents' arms, away from hightech hubbub. Comfort is key.
Quiet, dark environment, package, breastfeeding, rocking and holding, no unnecessary testing
Baby Care 101
Grossman says it's hard to do in the busy, noisy NICU.
In addition, there is no place for parents to live.
Yale pediatrician Rachel Osborne says they can visit and sit in a folding chair sandwiched between beds, but parents "often feel like they're outside and out of the way.
Faced with these and other obstacles, Grossman, Osborne and others are completely redefining their approach.
They are working on traditional practices, testing new ideas and going back to basics.
The result is dramatic.
"We respect the family and treat the baby like we do with the baby," Grossman said . ".
Parents have everything their children need, he said.
"It's not much more complicated than that.
Neonatal abstinence syndrome and opioid withdrawal in Maine, Vermont and West Virginia were the highest rates associated with maternal drug use.
Prices in Maine, Maryland, Massachusetts and Rhode Island were in 2012;
The rest is 2013.
Families today are more likely to handle the use of opioid drugs
Effects on newborns
More than ten years ago.
In 2004, the national NAS ratio has been low: one diagnosed with NAS for every 1,000 babies born.
When pediatrician Nicole Villapiano and his colleagues examined the rural and urban data, the ratio rose by 2013.
But in February, the researchers reported that rural areas were hit the hardest.
At a city hospital near the Providence River in Rhode Island, Vera piano witnessed the withdrawal of infant opioid drugs.
For the first time in 2011, she was assigned to a newborn nursery in Providence women and baby hospital.
"I imagine it will be a happy time to see the baby leave with their family and live a good life.
Reality quickly broke this hopeful situation.
On any given day, she may see several babies struggling to quit.
"These children are miserable," says Deborah apiano, now at the University of Michigan in Ann Arbor . ".
"Their crying is lasting, and their irritability is profound.
NAS is not easy to define.
The baby has various symptoms.
They sweated their backs, shivering and stiff.
The stool is loose, it is difficult to eat and sleep, and it is common to be grumpy.
Infants with NAS also have difficulty breathing, seizures, and low birth weight.
The syndrome was originally described with heroin. Exposed baby
Scientists now know that a variety of opioid drugs used during pregnancy can trigger this, including "maintenance" drugs used to treat opioid addiction, such as heroin or buprenofen as codeine and hydrokeone.
Not all infants exposed to intra-uterine opioid drugs are stopped --
It is not clear what conditions have led to the NAS.
How much of a particular opioid and pregnant woman used, did she take some kind of anti-depression, and even the number of cigarettes she smokes every day seems to be working, stephen Patrick and his colleagues at the University of Nashville-Vandenberg reported this in 2015.
For example, a non-smoking woman who has been taking oxycorone for a few weeks may need to deliver with a NAS. For a pack-a-
People who smoke every day take anti-depression drugs and dinonofen for six months, and the risk may exceed 30%.
Because opioid drugs are such a wide range of addiction drugs, opioid-
Ju Lee Oei, a neonatal scientist at the University of New South Wales in Sydney, said the use of mothers did not fully conform to one category.
"We need to know, Madam.
Smith had a bit of waiting on the road because of her back pain, and she might have a NAS baby, "said Oei.
Some women gave birth to NAS babies when recovering from opioid addiction
Alison Holmes, a pediatrician at Dartmouth Children's Hospital, said that although they were doing everything the doctor suggested
Hitchcock in LebanonH.
"Sometimes people think, 'Oh, these mothers are so terrible addicts, 'Holmes said. '".
But many times, "they will continue to take their heroin, they will continue to take dinonofen and they will control the symptoms --
But their kids still have to quit.
"No one knows exactly what effect opioid exposure has on the fetal brain, and how these children will be in the future.
Previous studies have shown that some areas of the brain may not grow correctly.
Children will also have vision problems and may have behavior and attention problems. One long-
Australian study published in February
Until 12 or 13.
Oei, co-author of the study, said whether this is caused by NAS is hard to say.
Poverty, child malnutrition and prenatal exposure to alcohol or other drugs may also play a role.
But for all these newly diagnosed babies, the result is a dangerous signal.
"You want your child to go to school and get good grades," Oei said . ".
But starting in the third grade, "These kids don't seem to be able to do that.
"Despite this, research on NAS outcomes and potential treatments in the United States remains blankS.
Government Accountability Office found
NAS does not have a national treatment plan.
"Everyone is doing it in their own way," said Scott wexblatter, pediatrician at Cincinnati Children's Hospital Medical Center . ".
More than 40 years ago, neonatal scientist Loretta Finnegan published a traditional approach to evaluating NAS, and now he works at the school of drug dependence in Philadelphia.
Nurses use detailed scoring lists more frequently to assess symptoms every 4 to 8 hours: Finnigan's newborn abstinence scoring system.
If you reach a certain score, the doctor will start to quit.
To relieve opioid drugs, usually morphine or heroin.
Wexelblatt said, but there is a push and pull between managing withdrawal and giving more medicine to infants.
"We don't want babies to be exposed to opioid unless we really need it.
"According to a June study, there is a big difference in the care of NAS babies in hospitals across the United States.
Some newborns take too much opioid.
To find out if standardized care can help the baby stop the drug more quickly, Wexelblatt and his colleagues trained the nurse on the Finnigan score and outlined a detailed plan for weaning.
This simple step is very different.
The average number of hospitals adopting the agreement was 31.
From 6 to 23 days before interference.
Seven days later, the team at Wexelblatt reported on 2015.
The duration of opioid therapy has also decreased.
To 2016, he said, the length of hospital stay dropped to 20 days.
54 hospitals now
Almost all delivery hospitals in Ohio
Wexelblatt said the weaning protocol was used.
Since then, the team has improved its approach, focusing on non-drug options for home support and care, such as packages and breastfeeding.
As of 2013, every delivery mother in the Cincinnati area had urine
Opioid testing was performed at admission to the hospital in order to start care as early as possible when needed.
Ohio's strategy is rewarding: Early results show that doctors treat NAS babies with fewer opioid drugs, and babies are discharged faster.
Researchers at Yale and Dartmouth
Hitchcock is also in the hospital approach, starting with the Finnigan scoring system.
Holmes and his colleagues reported in last June that some aspects were meaningless.
Nurses sometimes wake up sleeping babies, or take them out of the arms of family members for scoring, and they rate hungry babies because they cry.
Holmes recalled: "We said, 'This is crazy '.
It makes more sense to rate babies after they eat and when they are held.
In this way, nurses can screen out the actual signs of withdrawal from the normal call ines sound of hungry or tired babies, she said.
Grossman and colleagues at Yale are also skeptical.
Finnegan's system looks for warning signals such as vomiting and fever, but it also provides a basis for sneezing and yawning.
Final scoring guide.
"Is it really best to give morphine to a baby with 4 yawns instead of 3 yawns [scoring system]
They asked in a comment on February.
Grossman searches scientific literature for clues to improve treatment.
But the results are rebounding everywhere.
"We finally questioned everything," he said . "
"It turns out that there is no good answer to anything we are doing.
"Around the same time that Grossman went into the deep study of the withdrawal of neonatal opioid drugs, he had his first child and he kept screaming.
"I was pacing in the middle of the night and thought that if it was a NAS baby, he would be treated immediately.
As a result, Grossman shook and held his son while pacing.
All the tricks parents use to appease a grumpy newborn.
When he found a solution to the baby problem, he thought, what if the NAS baby needed some ideas similar to his experience in the hospital.
Sometimes it's good to remove the baby for a few days.
Their mom was there and Finnigan had a very low score.
But if the mom had to leave, the baby would go backwards and the score would soar again.
"Do these children need more moms or more medication," Grossman and colleagues thought ? ".
"We started thinking, 'Well, maybe more moms. Dartmouth's "great"
Hitchcock, Holmes and her team put forward their own ideas.
The team stopped the strict interpretation of Finnigan's score.
But their biggest change is to keep the mother with the baby. 7.
It's called Room-
Previous studies in Canada and other countries have shown that this may ease the transition of infants from the womb to the world.
"What is needed to withdraw the baby is a calm, quiet, dark place where a loving person can keep them," Holmes said . ".
Her team is focused on getting mothers and families involved (
Even volunteers hug)
Intuition is rewarded.
The average stay time of morphine from 2012 to 2015
NAS babies treated declined from 16 years old. 9 days to 12. 3 days.
The proportion of infants taking morphine also dropped from 46% to 27%.
Two years later, the number has fallen further.
20% now, she said.
Holmes said that her own child joked about her work: "a baby like a mother --
What a discovery!
"They're a little right," she said with a smile . "
Grossman's team at Yale has driven the family.
Focus more. “Our mind-set is rooming-
"Take steroids," he said.
Parental care is considered more important for NAS-
More effective-Than drug treatment.
The doctor asked the parents, "How do we get you here, Dad here, grandma here," Grossman said . ".
"Because this is what your child needs.
"His team has also come up with other ideas, such as intensive formula milk and pumped breast milk with extra calories.
Hospital staff stopped using the Finnegan score to guide drug doses.
Today, they evaluate based on three simple parameters: whether a baby can eat, sleep and be comforted.
The ward that parents can lower with their children is different from the NICU.
A room at Yale has a sofa that can be converted into a bed and ceiling with photos of Elmo and Tweety Bird.
The monitor was muted, nothing kept beeping, and natural light poured in from the windows.
Parents have enough space to walk around and take care of their children.
In these rooms, "it feels like parents are a necessary part of the care team," says Osborne of Yale University . ".
In 2016, babies with NAS stayed at Yale hospital for only five months. 9 days —
Cliff diving compared to an average of 22 2008-2010.
On May 18, Grossman, Osborne and his colleagues reported on the Internet.
What's more, the proportion of these infants receiving morphine treatment dropped from 98% in 2008 to 2010.
Proportion of opioid drugs from 2008 to 2016
Infants treated with morphine at Yale's New Haven Children's Hospital dropped from 98% to 14%, which greatly reduced the number of infants taking the drug.
Grossman said that Yale's approach basically boils down to common sense: a quiet room, a lot of holding, feeding when hungry, and simply putting the baby with mom and dad.
"This is not rocket science," he said . "
Medication is more like Plan B.
Nevertheless, other doctors who wish to change the treatment of NAS may encounter obstacles. Not all U. S.
Set up a hospital like Dartmouth.
Mr. wexblatter says Hitchcock or Yale New Haven.
Once the mother is discharged from the hospital, she does not always have room to stay with her children.
He warned that universal drug testing for mothers would not work anywhere.
In Tennessee, a law passed in 2014 allows new mothers to be prosecuted for using illegal drugs during pregnancy if a newborn is injured.
Wexelblatt said the law expired in last July, but such legislation removed women from health care.
The best care for the baby may begin with care and compassion for the mother.
Holmes said, "We need to do our best to support the mother as a good parent rather than blaming the mother. ood parents. ”