Report calls for shift in care for newborns exposed to opioids in the womb

During an opioid epidemic that has rocked Alberta and other regions of the country, doctors are urging a shift in care for the youngest victims of the crisis — newborns.

Health authorities have seen rising numbers of these cases across Canada

Doctors have reported an increase in the number of babies exposed to opioids while in the womb. (Canadian Press)

During an opioid epidemic that has rocked Alberta and other regions of the country, doctors are urging a shift in care for the youngest victims of the crisis — newborns.

Health authorities across the country have reported a rise in the number of babies born after being exposed to opioids in the womb.

According to the Canadian Institute for Health Information, about 1,850 infants were born exposed to addictive drugs in 2016-2017, a 27 per cent jump from similar births reported in 2012-2013.

In these cases, doctors have traditionally moved the babies to neonatal intensive care units and sent their mothers home, said Dr. Thierry Lacaze, a pediatrics professor and a member of the Alberta Children's Hospital research institute.

Keeping mom, baby together

In a report released Thursday, the Canadian Paediatric Society said keeping mom and baby together is better for the child's health.

"Supporting the mother in breastfeeding her baby [will] actually reduce the need for morphine, reduce the need for NICU (neonatal intensive care unit), reduce the length of stay," said Lacaze, co-author of the new recommendations for care.

Babies exposed to opioids in the womb are often born addicted and need to be weaned from the dependence after birth.

Some withdrawal symptoms, such as trembling, seizures and stuffy nose, appear in the first few days of life. Other effects, including irritability, sleep disorders and feeding problems, can last up to six months.

Instead of the traditional method of weaning babies with morphine, doctors now recommend that mothers breastfeed the child as part of the weaning process, because the milk contains opioids.

Once babies are discharged from hospital, he said a team of doctors must ensure the infants sleep and eat well, gain weight and adapt to their environment.

"You have a single team working with the family from before birth to back home," he said.

We think our crisis is bad now, but what's it going to be like in 15, 16 years from now when these kids age?- Dr. Esther Tailfeathers

Dr. Esther Tailfeathers, a family physician with the Blood Tribe, said her community — like others across the country — has seen rising numbers of infants affected by opioids.

The long-term effects for these children are not fully known, but Tailfeathers said they likely have a higher risk of becoming addicted later in life.

"We think our crisis is bad now, but what's it going to be like 15, 16 years from now when these kids age?" she said, adding she backs the new recommendations.

Lacaze said the increase in babies exposed to addictive drugs reflects both mothers addicted to illicit opioids, such as street fentanyl, and those who have been prescribed opioids to manage their pain.

According to the College of Physicians and Surgeons of Alberta, per capita prescribing of the top five opioid painkillers — oxycodone, hydromorphone, codeine, morphine and fentanyl — was flat or down in 2015 and 2016.

Opioids prescribed 'too freely'

An escalating death toll from fentanyl and other opioids triggered considerable soul searching in the healthcare profession.

The college set new prescribing standards last spring after concluding physicians prescribe opioid painkillers, such as codeine and oxycodone, "too freely."

Still, Lacaze said doctors have seen an increase in the number of mothers taking painkillers in the past five years, which he believes is reflective of a larger trend.

"There are more individual adults prescribed opioids for pain management," he said, noting he's consulted by colleagues about pregnant women on prescribed painkillers once or twice a week.

Lacaze recommends pregnant women should switch from their painkillers to an opioid replacement drug such as methadone during the pregnancy and remain with the child after birth.

Doctors, he said, should also try this approach with mothers who are addicted to illicit opioids, though he said it won't be possible in every case.

"If they are showing signs of maturity and evidence that they can take care of their babies, then we would try to keep them together after birth instead of separating them," he said.

Alberta's Ministry of Children's Services said in a statement it's important to keep mothers and children together, "which is why we work with at-risk families and support parents to care for their children whenever possible."

"Ultimately, the courts decide whether apprehension is in the best interest of the child, based on the specific requirements outlined in the Child, Youth and Family Enhancement Act."