Delaware County Medicine & Health Winter 2017 - 9

Dr. Darcy Hayes and Dr. Robert Noll are pediatricians at
the forefront of this fight working as pediatric Hospitalists
at CCMC. Despite their best efforts, after being discharged
from the hospital, 4 of the 150 infants who were born drug
addicted and treated for NAS at CCMC between 2013 and
2015 have already died from various reasons. This death rate
is dramatic when compared to children born in Delaware
County to non-addicted parents and this number does not
include deaths of children and infants living in our county
who were born drug addicted and treated outside of the
Crozer system. Years ago when I was one of the doctors
caring for these children at CCMC (1997 - 2003), NAS
babies accounted for such a small number of patients we
didn't even keep statistics on them; unfortunately, this is no
longer the case. As a community we can no longer afford
to ignore the existence of addicted babies and the countless
number of other victims of this opiate crisis.
The severity of symptoms experienced by NAS babies
and the length of time they have to stay in the hospital
to wean off drugs depends on numerous factors - all of
which relates to their drug addicted mothers. Some of
these factors depend on the type of opiate their mothers'
used; how long these women used the drug/s during their
pregnancy, the amount of the drug (the dose) that is used,
and the gestational age of the infant. Not all of the drugs
used by these women are illicitly used, sometimes they
are prescribed. After birth, withdrawal symptoms can
present as early as 24 hours or may be delayed as long as 6
days. The symptoms experienced by these babies include:
poor feeding, tremors, generalized seizures, high-pitched
inconsolable crying, jitteriness, sweating, fever, excessive
sucking or rooting, vomiting and diarrhea. These infants
often require pharmacological treatment with morphine to
prevent seizures and to control their symptoms. It can take
more than a month of hospitalization to successfully wean
these babies off their treatment and then they are discharged
to a challenging and uncertain future.
In every case of a drug addicted infant, a referral must
be made to Children and Youth Services (CYS). It is
disconcerting that even with the passage of time there
continues to be a significant disparity between the medical
community and the child protective services community.
As physicians, we feel very strongly that an active drug user,
especially an active opiate or methamphetamine user, is
incapable of appropriately parenting a well infant, let alone
an infant with a history of a drug dependency. Providing
a CYS mandated "support person," who is usually a loving
relative or close friend of the addicted adult is ideal in theory
- however, too often falls short as these support people are
completely overwhelmed with the responsibility of raising
a child and supporting an addicted adult through one of
the most stressful periods of their lives. It is difficult and
challenging to protect these children when they are placed

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into the home with active drug users. With the number of
cases of NAS babies increasing each year can we continue
to ignore the social circumstances we are sending these
children home to when we know that it puts them at risk of
readmission and even death after their hospital discharge?
We need to come together as a community to protect these
children. Inpatient physicians do their part by providing
initial care in a protected environment to safely wean these
infants from their drug dependency. They lose contact with
these patients after discharge and rely on CYS caseworkers,
Early Intervention, out-patient physicians and many other
community organizations to provide critically needed support
to these families. The follow-up after discharge is greatly
lacking in our county and around the nation resulting in
increased morbidity and mortality in these young patients.
We hope that bringing attention to this serious issue will
be a catalyst for the formation of a cohesive, organized,
multidisciplinary way of targeting this ballooning problem in
Delaware County.
-------------------------------------------------------------------------Jessica Small, MD, Third Year Pediatric Resident,
Crozer Chester Medical Center

www.delcomedsoc.org

DELAWARE COUNTY MEDICINE & HEALTH

http://www.delcomedsoc.org

Table of Contents for the Digital Edition of Delaware County Medicine & Health Winter 2017