Neonatal abstinence syndrome: Small victims in a big opioid crisis

Newborns cry, but not like this.

Thirteen months ago, Courtney Castonguay held her daughter Emma in her arms as the baby cried incessantly.

A "high-pitched" cry, Castonguay said, different from the other babies around her at a Hamilton hospital.

Castonguay tried everything in her power to comfort her little girl, but she knew only one thing could.

"I felt like the worst mother in the world," Castonguay said in an interview. "She was suffering because of my choice."

Castonguay, 21 at the time, suffered too — tormented with guilt and fear.

She was addicted to opioids at the time, having used them regularly since high school.

During her pregnancy, she was taking hydromorphone and fentanyl, but was too afraid and ashamed to tell her doctor.

"I hid it the whole time. The entire nine months," Castonguay said. "I was scared she was going to get taken away from me."

Once she saw how sick Emma was, she told doctors, who quickly confirmed the baby was born with an addiction. But Emma has since been treated and is doing well.

Hundreds of NAS babies

Emma is among hundreds of Canadian infants hospitalized last year with neonatal abstinence syndrome (NAS).

They are the small, innocent victims of an opioid crisis, which policymakers and health-care officials are struggling to contain.

Between April 2016 and March 31, 2017, the Canadian Institute for Health Information (CIHI) identified 1,846 babies admitted to hospital after their mothers used opioids during pregnancy.

The tally does not include Quebec, which keeps its own statistics.

More than half the cases — 988 — were in Ontario, where CIHI has tracked a steady increase in NAS since 2012.

The numbers back up what health-care providers have been witnessing first-hand.

Taking a toll on health care

At St. Joseph's Healthcare in Hamilton, social worker Sarah Simpson says the neonatal unit, where she has worked for 20 years, used to treat approximately one baby for NAS every six months.

Now the unit is treating between two and five babies for NAS at all times.

Emma, like other babies with NAS, receive morphine therapy to slowly wean them off the opioids that created the addiction. Treatment in hospital takes anywhere from four to five days, to six to eight weeks.

Hospital staff continue to monitor babies with NAS and their parents for 18 months after birth.

"It's really difficult for the staff," Simpson said in an interview, adding that the babies require "constant care," at a time when parents aren't always available to stay with the newborns in the hospital.

The parents also need support.

"There's a lot of shame. There's a lot of guilt," Simpson said. "We're not here to to judge."

The rising numbers of NAS babies are stretching hospital resources thin, and Simpson would like to see the establishment of a centre similar to Fir Square Combined Care Unit​ at Vancouver's B.C. Women's Hospital.

The centre is the first in Canada to care for women who use substances and their newborns exposed to substances, in a single unit.

Dr. Maya Nader, who specializes in addictions at St. Michael's Hospital in Toronto, says the increase in NAS is a burden on the health-care system, requiring more hospital beds, pediatricians and nurses.

"I'm worried because, in general, there is too much opioid use in the population," Nader said in an interview.

She attributes the higher rate of NAS in Ontario to its larger population and higher rates of opioid use.

Looking for solutions

Ontario Health Minister Eric Hoskins says the government is addressing the opioid crisis, but "there's always more work to be done."

In an interview, he said ministry staff will be investigating why far more babies are born with NAS in Ontario than other provinces.

"We've got tremendous expertise on this issue. I'm confident we can not only have a clearer determination of what the reasons might be, but what specific support and interventions would prove helpful," Hoskins said.

Emma's recovery

Support is what got Castonguay and Emma through.

Now 13 months old, Emma is happy and healthy. After early struggles, she's at a healthy weight and her recovery is ahead of schedule.

"She's come so far, I can't even believe it," Castonguay said.

But it wasn't easy.

"You've got to have the right support. Some people can't handle it. It's just too hard to watch a baby go through that. Especially your own baby."

Castonguay is grateful to have received the support she needed and hopes others will get it as well, as the opioid crisis worsens and more babies are born with NAS.

"I got lucky and she's an amazing little girl."