In Virginia, eight babies per 1,000 births are born with neonatal abstinence syndrome. “We’ve seen numbers consistent with that,” says Dr. Ashraf Afifi, a Children’s National Hospital neonatologist and SNVMC’s NICU medical unit director. “In 90% of these cases, the mom didn’t plan the pregnancy. She realizes she’s pregnant late and unfortunately comes late to care or right at delivery.”
The baby looks stable for the first few days, Afifi says. As drug blood levels drop, the baby then shows signs of withdrawal syndrome. Awake, crying, irritable, inconsolable, sweating, they have diarrhea, difficulty gaining weight. Urine tests detect current drugs, but umbilical cord tests have a longer memory of substances in pregnancy (they must get consent). They’re treated with a sedative—oral methadone or morphine—and extra calories, minimal external stimulation, low lighting in a separate nursery and swaddling.
Joanne McCoubrey, a Sentara NICU nurse for 30 years, has seen “more and more” drug-addicted babies, with opioids encompassing the majority. “It’s absolutely heartbreaking.”
NAS babies—who might stay two to six weeks—are consoled by being held, she says. That often helps them through withdrawal quicker, decreasing stays. The nurses can’t hold babies entire shifts, so McCoubrey created Arms of Love, training hospital volunteers to cuddle babies in withdrawal. Currently, 14 volunteers (and more on a waiting list) work three-hour shifts. She’s recruiting more volunteers as it “takes a special kind of person to come in the middle of the night.”
They record feedings, diapers, rashes. “They’ve held screaming babies, they’ve gotten thrown up on. They really get to know the baby. They do a fabulous job,” McCoubrey says.