Healing Babies, Empowering Moms: Treating Neonatal Abstinence Syndrome

Since arriving in Bangor 13 years ago, neonatologist Mark Brown, MD, MSPH, has headed the Neonatal Intensive Care Unit (NICU) and helped develop a comprehensive program for babies born exposed to opioids. Babies born to mothers with substance use disorder develop Neonatal Abstinence Syndrome or NAS. “We see tremors; we see irritability and discomfort,” explains Dr. Brown when describing the symptoms of babies with NAS.

To say to the mom that we feel you’re responsible enough to help us take care of your baby with withdrawal is huge. - Mark Brown, MD, MSPH

Dr. Brown says they saw about 200 babies born with NAS at the peak of the opioid crisis in 2015. That number dropped to 135 in 2018. Recent advancements in assessment and treatment of babies with NAS involve using fewer medications and adopting a new assessment tool called Eat, Sleep, Console, or ESC, which was developed by researchers at Yale and Dartmouth Hitchcock. It is similar to a philosophy Dr. Brown and the NICU team began practicing about four years ago. “If the baby can’t eat, can’t sleep, and can’t be consoled, this becomes the threshold to use medication treatment,” Dr. Brown explains.

The goal is to use less medication so the baby can be discharged sooner and cared for at home. The other part of this treatment philosophy is to allow the birth mother to take a more proactive role in the treatment of her child. To facilitate this approach, Dr. Brown has worked in a partnership with Penobscot Community Health Care to create an outpatient clinic where mothers bring their babies for checkups every two weeks and get prescription refills for treatment. “To say to the mom that we feel you’re responsible enough to help us take care of your baby with withdrawal and allow them to participate in the solution is huge,” he says. 

Neonatologist Mark Brown, MD, MSPH looks in on a baby in the NICU.

Dr. Brown explains that in about 15 percent of cases the mother is not ready for this responsibility. In such cases, a support network is essential. This is where Lauri Legere comes in. As a foster parent who has taken in 15 children born with NAS over the last 20 years, Lauri has always welcomed the biological mom to be involved because she feels that this is important for the child and mom.

“I look at the bigger picture. I look at this amazing start I can give to this child and their parent—establishing a foundation that the biological parent can build upon. For two years, I work side-by-side with the biological parent, giving support, love, encouragement, and all those things that maybe they’ve never had,” explains Lauri.

Lauri says all her foster children’s biological moms love their children, but some have just not been capable of taking care of a child until they could take care of themselves. While most of the children she fostered were able to return to their parents or other relatives, she is an adoptive parent to six of the children she took into foster care, including two sets of siblings. Those children range in age from 3 to 20. They have all faced health challenges but have thrived by being raised in a loving and nurturing home.

Lauri Legere and her husband, pictured with five of their six adopted children and their biological daughter (top center), are foster parents who have taken in 15 children born with NAS over the last 20 years.

“We cannot grow as a community and society if we believe people can’t change. The biological parents may be dealing with substance use disorder or mental health issues, but we must believe that they can change. We have to believe that we can support their journey,” concludes Lauri.

Dr. Brown says that’s the most significant part of what he tries to teach and the key to helping mom and child both succeed, and to helping end the cycle of opioid misuse.

For more information and treatment options for opioid use disorder, visit https://northernlighthealth.org/Maine-Opioid-Crisis