Newborn addictions rise, triggering new hospital rules

Following an increase in babies born with drug or alcohol dependencies in Delaware, statewide hospital discharge forms for "high-risk" cases will be amended to ensure that the baby will go home to the safest environment and mom will have the necessary support system in place.

A committee of medical professionals, community leaders and state officials charged with studying and recommending how to care for infants who are born substance-exposed or medically fragile voted to add six conditions that will automatically trigger high-risk medical discharge reports from the hospital to the Delaware Division of Family Services.

The move is one of the first steps the committee, an arm of the Child Protection Accountability Commission, has made to figure out how to best help babies born with the dependencies and their families thrive.

The conditions originally were crafted by the Delaware Healthy Mother and Infant Consortium, a group that reviews and recommends programs and guidelines concerning maternal and fetal care.

The conditions are:

• Significant noncompliance with care of the infant, such as not visiting or participating in care.
• Mom is using substances, but is not in a treatment program.
• Evidence that drug use impairs caregiving ability.
• Addicted infants must stay in the hospital for more than 30 days.
• Multiple substance use.
• Infant needs medically complex care.

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According to the form that is submitted to DFS, a high-risk medical discharge is called for if there is an "increased risk for physical, developmental, behavioral or emotional conditions that require health and related services of a type or amount beyond that required by a child generally, and the child’s family is unable or unwilling to provide or ensure the necessary care."

If a pregnant woman heavily uses opiates, such as heroin, codeine, oxycodone and even methadone or buprenorphine – which are used in drug treatment, those substances filter through the placenta. The baby is then born drug-dependent and soon suffers withdrawal.

When an expecting mom drinks alcohol while the baby is developing in the womb, the baby can develop fetal alcohol syndrome disorders as well.

Jennifer Donahue, child abuse investigation coordinator of Delaware and co-chair of the committee, said it is important a plan of safe care is established for these children when they leave the hospital.

Hospitals are already required to report to Delaware Division of Family Services if a baby is diagnosed as being substance exposed or with a fetal alcohol spectrum disorder.

There were 448 reports made in 2015. Not all require follow-up, however. DFS investigated 299 cases of babies who tested positive for drugs and 68 who tested positive for alcohol.

But the follow-up for families can be inconsistent, Donahue said.

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State and community agencies are doing "damage control" now to try to connect families to services such as home visiting nurses and are tasked with investigating near-death, injury and death instances that involve drugs. For instance, such a child death could be the result of a mom on methadone rolling over onto a baby in bed, suffocating the infant.

Draft legislation is in the works to formalize a plan of safe care for babies that will engage social workers, nurses, hospitals and other groups to ensure that families will not fall through the cracks and the baby is not in danger. Mothers would need to sign off on the plan at the hospital and would be monitored to make sure they are following it appropriately.

"We are trying to make it clear and formal," Donahue said. "It's not a discharge plan; it's a follow-through plan."

Without action, then "we are going to have dead babies," she said.

Others, such as Dr. David Paul, chair of the Delaware Healthy Mother and Infant Consortium and head of pediatrics at Christiana Care Health System, feel that the legislation is not the cure-all.

He is concerned that the legislation would actual deter moms from getting prenatal care or dissuade them from drug treatment. The legislation may be part of the solution, but it's not the only solution, Paul added.

"There's not going to be a silver bullet," Paul said.

Jen Rini can be reached at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.