Florida Babies are “Collateral Damage” in the Opioid Crisis

Dec 7 • 100 Views • View Comments

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Passidomo makes the case in new video for a
Neonatal Abstinence Syndrome Pilot Project

Senator Kathleen Passidomo today released a video highlighting the devastating impact the ongoing opioid crisis is having on Florida’s babies. The Senate Health and Human Services Budget Committee will today hear Senate Bill 434, Passidomo’s proposal to establish a Neonatal Abstinence Syndrome Pilot Project.

“We have a responsibility to the babies being born into the devastation of the opioid crisis,” said Passidomo. “The Neonatal Abstinence Syndrome Pilot Project takes important steps toward ensuring these babies are not left behind while we as a society work toward tackling the larger crisis we are facing.”

SB 434 Background

Most of babies in a hospital’s Neonatal Intensive Care Unit (“NICU”) are there because they are critically ill, suffering from complications due to prematurity, difficult delivery, or some other birth-related malady.  In addition, there often are babies admitted to the NICU who are suffering from drug withdrawal because their drug-addicted mothers continued to use or abuse opioids (both prescription and illegal drugs) during their pregnancies.  The babies born to these mothers suffer from Neonatal Abstinence Syndrome (“NAS”).

Illicit substances and prescription drugs that cause drug dependence and addiction in the mother also cause the fetus to become addicted. At birth, the baby’s dependence on the substance continues. However, since the drug is no longer available, the baby’s central nervous system becomes overstimulated causing the symptoms of withdrawal – many of the same symptoms experienced by adults.

In order to manage the more painful symptoms of withdraw, babies are given morphine, methadone, phenobarbital, chlorpromazine, diazepam, clonidine, or a combination of these drugs to provide symptomatic relief.  The severity of the symptoms and the length of time a baby is given pharmacological treatment vary depending on the type of substance used by the mother, the last time it was used, and whether the baby is full-term or premature.

Why is SB 434 Needed?

Currently, the only place to treat NAS babies who require pharmacological treatment is in the NICU.  The cost to the hospital system and Medicaid is enormous.  It is estimated that the mean length of hospital stay for a NAS baby is 23 days (verses 2.1 days per full-term, non-NAS baby) and the average cost is $93,400 per NAS baby (verses $3,500 per full-term, non-NAS baby).  These are only averages.  There are cases of NAS babies requiring NICU care for two months or more. The cost for over 80% of all NAS babies is covered by Medicaid.

But much of the equipment and services available in the NICU are there for critically ill babies.  After a NAS baby is stabilized, most of the equipment/services of a NICU are not needed during a baby’s withdrawal period.

Moreover, after stabilization, the NICU is not always the best place for a recovering NAS baby.  In the NICU, all babies are attached to monitors restricting movement.  The NAS babies tend to be overstimulated due to bright lights, loud noises/alarms, and busy surroundings.  Babies are typically fed every three hours even if they are not yet awake.  There is also minimal support for families and decreased access to social services.

Imagine spending literally hours trying to calm an inconsolable NAS baby in the NICU and finally getting that baby to fall asleep, only to have an alarm – possibly his own, maybe an alarm for the baby in the next bed – jerk the NAS baby awake and the cycle of crying starts all over again.

While a NICU is not the best place for a recovering NAS baby, it is currently the only option available for these babies in Florida if they require pharmacological treatment.

What does SB 434 do?

If adopted, SB 434 will authorize the Agency for Health Care Administration (“AHCA”), in consultation with the Department of Children and Families (“DCF”), to establish a pilot project to license one or more facilities to treat NAS babies after stabilization, offering a community-based, lower cost, more baby-centric alternative.

AHCA, in consultation with DCF, will be given authority to adopt regulations, including, among other things, requirements for a facility’s:

  • Staffing
  • Physical plant and its maintenance
  • Programs, services, and care provided to infants being treated
  • Maintenance of medical records and other relevant information

SB 434 also specifies minimum requirements in order to obtain a license and participate in the pilot project.

Much is unknown about the appropriate treatment for NAS infants or the long-term effects on the infants of the current treatments.  Accordingly, SB 434 directs the Department of Health to contract with a Florida state university to study the risks, benefits, cost differentials, and transition of infants to specified social service providers.

The type of facility envisioned by SB 434 is a home-like environment with individual rooms providing minimal stress on the babies; a quiet, dark environment; slow, gentle handling to ease the pain of withdrawal, and accommodations for eligible mothers to breast feed and bond with their babies during the withdrawal process.  All medical services will be overseen by a medical director and will be staffed with at least 2 registered nurses for each 12-hour shift, 24 hours a day, seven days a week.  Since these babies are not critically ill, they will generally not be attached to monitors measuring their heart and respiratory rates.  This, along with the elimination of the associated alarms, will increase the babies’ comfort and reduce the chance of overstimulation.  Each baby will dictate when it is fed.  Breastfeeding and skin-on-skin contact with the mother will be encouraged.  Trained volunteer snugglers will be available to comfort and cuddle babies who are otherwise inconsolable.  An established weaning protocol will be developed, adopted, and supervised by the medical director who will be a local neonatologist.  Age appropriate, developmental care will be provided for the infants. Basic childcare, follow up care for NAS babies, and good parenting classes will be available for mothers and fathers.  Parents will also be taught infant CPR and the safe sleep initiative.  The facility will work with social services providers to educate parents and transition babies after discharge.

This type of private facility will provide more appropriate care for NAS babies given by registered nurses and overseen by a medical director for a fraction of the cost incurred by hospitals.  Due to a greatly reduced overhead and NAS-specific care rather than the critical care provided in a NICU, it is estimated that the cost per baby per day at the private facility would be approximately $800 verses approximately $4,000  in a NICU – a savings of 80%.

 

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