Methadone babies

Specialties NICU

Published

A child that was born on December 10th, her methadone level when she left the hospital on December 20th was at 3, now the newborn is in ICU with a level 13 and the hospital has her on morphine. I don't understand how this happened? Her mother is on a Methadone program and is allowed to take some home on the weekends. Im trying not to jump to bad conclusions but Iam terrified for this child.

Up Vote Up Vote ×
Specializes in Neuro, Telemetry.

Maybe she is breastfeeding even though she probably shouldn't be?

Up Vote Up Vote ×

I immediately thought breastfeeding.

I agree with your alarm. A 'methadone' baby is going to be a more irritable and less easily consolable baby for a while after the protocol has completed. A mother needing methadone to cover her is a mother with fewer coping skills ESPECIALLY for the hard parts of life -- like an inconsolable infant. I can 'imagine' the mother or whoever being overwhelmed by a crying baby and reaching for any quick solution, like maybe she's still having a little withdrawal? Why not give her a little . . .

And the mother KNOWS what withdrawal feels like, and perhaps is imagining her baby suffering what she's suffered? What helps the mother helps the child :( .

What is the team thinking about this?

Up Vote Up Vote ×

Thank you for your answer this makes much more sense of what was going through my head. The mother is not breastfeeding. The infant was born in a city hospital so the child was released before withdrawal. (Bellevue, NY, NY)

Up Vote Up Vote ×

Breastfeeding actually isn't contraindicated (its actually encouraged) for babies going through NAS so long as the mom doesn't stop abruptly.

I'm wondering what you mean by "methadone level" do you mean NAS score?

Up Vote Up Vote ×

Thank you katierobin23, and yes I do mean NAS score.

Up Vote Up Vote ×
Specializes in mom/baby, EFM, student CNM, cardiac/tele.

I had a baby this week that was consistently scoring 4 and below and the family was going to be discharged. Luckily, the dr decided to keep them another night and he ended up scoring 14 that morning. Sometimes it just takes longer than others, I think.

Up Vote Up Vote ×

Oh, that makes sense with the scores. Methadone has a very long half life, thus the use for maintenance therapy. I took care of people withdrawing from methadone, it can last for weeks because of that long half life.

I'm surprised the infant wasn't kept inpatient from birth to treat the withdrawal?

Up Vote Up Vote ×

Babies with NAS do not present immediately after delivery. Depending upon which drugs the mother was using, onset might be delayed 10 days to 2 weeks. And Katierobin23 is correct; breastfeeding is not only encouraged, it can actually lessen the symptoms associated with NAS.

It is a common belief that breastfeeding is contraindicated in nearly all cases of maternal drug use. This is a sacred cow in both nursing and medicine that should have been put to pasture years ago, as breastfeeding is safe with many medications.

There are several sources available that provide information regarding drug use and breastfeeding. The National Institute of Health maintains the LactMed database. LactMed is available on line without charge, and is available as an app for both Android and Apple based devices.

Up Vote Up Vote ×
Specializes in L/D 4 yrs & Level 3 NICU 22 yrs.

People (doctors and nurses) who care for infants with NAS should have a basic knowledge of what NAS is and how it affects infants. A strong foundation is necessary to help educate families, provide proper care, including establishing a protocol followed by all members of the healthcare team (which helps decrease LOS and costs, and increases parent satisfaction) and dispel myths so that everyone is well-educated. This promotes teamwork as well. The newborn nursery staff should also be educated since many infants with NAS are born at term, and may never be admitted to the NICU. A non-punitive attitude and environment is most conducive to gaining confidence from the mother which will enable the team to determine the best modes of treatment for the infant's withdrawal symptoms. Infants can withdraw from a wide variety of drugs, not just opiates.

Up Vote Up Vote ×
Specializes in Community, OB, Nursery.

If mom was on a bigger dose, I can see how sx did not show up until much later due to methadone's very long half-life. We keep our NAS for a minimum obs period of 5 days. Other posters made good points; if babe was not on meds during her previous hospital stay, she was most likely around nurses who have lots of tricks up their sleeve when it comes to comforting NAS kids. Mom/family likely do not know all those same tricks. We have had many a mom room in the night or two before anticipated d/c and they're gobsmacked at how high-needs those kids can be.

A lot of our moms on methadone do breastfeed and those babies actually do really well overall. The trick is knowing what else - if anything - Mom is currently using. If methadone is all, or it's methadone + other things that we know are ok for breastfeeding, we like for Mom to BF/pump. Street drugs are a no-no, but benefits of breastmilk far outweigh risks of small doses of methadone. And it really does help Mom to know that she's providing something for her baby that no one else can.

Up Vote Up Vote ×
Specializes in Neuro, Telemetry.

Chare and others. Just wanted to note I am a student about to start my peds/OB semester and didn't realize I had ventures out of the student forum on this topic. I sometimes read the "latest" stuff for information. Thanks for the info on breastfeeding during withdrawal. I'm sure it will be useful very soon. I'm also glad to see that it's actually a good thing to breastfeed in most cases because breast milk is so beneficial.

Up Vote Up Vote ×
+ Add a Comment