Dr. Kimberly Spence is a neonatologist with St. Louis University and SSM Health-St. Louis.
She’s also a member of the Show-Me Echo that focuses on mothers, infants, and Neonatal Abstinence Syndrome (NAS).
This is a regular, virtual convening of medical professionals from across the state that works to share best practices of how to care for these at-risk infants and their mothers.
For the month of September, we’re focusing on substance use disorders and some of the treatment options that exist for Missourians.
Dr. Kimberly Spence: I think that in the very beginning, a lot of smaller delivery hospitals did not have the expertise or feel comfortable in managing these babies.
They require intensive services. They really do. They require a lot of nursing, social work, sometimes they require occupational therapy or speech therapy to assist with feeds.
The sort of symptoms that babies demonstrate from opioid withdrawal are poor feeding, irritability, increased tone.
And they have been shown to, now, also have increased risks of developmental delays later in life as well as in early childhood. So, maybe there is a long term impact from in-utero opioid exposure.
But what we have found is that, specifically the quality improvement study that we did here in St. Louis at SSM St. Mary's — we demonstrated that 75% of babies can actually stay with their mom in their original hospital, not need to be transferred out to tertiary referral centers, if you're able to practice something called “Eat, Sleep, Console.”
"Moms really benefit from the self-esteem that they get from being able to say, 'I'm able to provide care for this child.'"Dr. Kimberly Spence
And it truly is an optimization of non-pharmacologic care and involvement of the mother in the care of this infant.
With all of those variables optimized, 75% of the time the children could remain with their mothers and at these rural hospitals.
So, that was kind of how it began: was how do we have outreach to teach these other hospitals and healthcare providers how to feel comfortable caring for this dyad during this early newborn period.
And the other issue is, is feeling comfortable, but also having the resources to do so — having the social worker, potentially having the therapy services, knowing when to refer, knowing when that child actually did need a higher level of care.
So, what this does is it empowers the mom. The mom learns what the baby needs to console, and those are important life skills that she needs for when she takes this child home because Neonatal Opioid Withdrawal (NOWS) does not end at discharge.
A lot of those symptoms they take a long time to get better — months, and, as I said, there are some long term neurodevelopmental issues with children who have had in in-utero opioid exposure.
So, I think that these moms really benefit from the self-esteem that they get from being able to say, "I'm able to provide care for this child,” and they also benefit from that that bonding, and so does that baby.
So, it's just been critical. It's been really, like I said, revolutionary in the management of infants with opioid withdrawal.
