Pardon my profanity, but what the fuck is wrong with people?
That was my thought when I read a paper published yesterday in JAMA Pediatrics. The paper is Association of Rooming-in With Outcomes for Neonatal Abstinence Syndrome; A Systematic Review and Meta-analysis by MacMillan et al.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It sounds like a particularly ghastly joke, but sadly it isn’t.[/pullquote]
In this systematic review and meta-analysis of 6 studies comprising 549 patients, rooming-in was associated with a reduction in the need for pharmacologic treatment and a shorter hospital stay when rooming-in was compared with standard neonatal intensive care unit admission for neonatal abstinence syndrome.
Wait, what? We can save money on the care of drug addicted newborns by forcing their mothers — mothers who may lose custody — to room in with them and take care of them? Do the authors of the paper, and the people who reviewed and published it have any idea just how screwed up that is?
Consider the problem:
Neonatal abstinence syndrome (NAS) is a collection of signs and symptoms of newborn opioid withdrawal after intrauterine exposure. Other descriptions of the syndrome include neonatal opioid withdrawal syndrome and neonatal withdrawal syndrome. Neonatal abstinence syndrome manifests 24 to 96 hours after delivery with increased muscle tone, tremors, sweating, vomiting, diarrhea, and other symptoms. Between 1999 and 2013, the incidence of NAS in the United States increased from 1.5 to 6.0 cases per 1000 births,3 with a mean cost in 2012 of $93 400 per newborn stay.
So let me see if I get this straight: Opioid addicted newborns cost a lot of money because they need specialized care for their suffering: increased muscle tone, tremors, sweating, vomiting and diarrhea. The incidence of newborn abstinence syndrome is rising because the incidence of maternal opioid addiction is rising.
There are lots of ways we could address this issue. We could provide greater oversight of the pharmaceutical industry to prevent opioid addiction; we could provide better care for those addicted to opioids; we could provide specialized treatment programs for pregnant opioid addicts. Those measures would work by decreasing the number of infants forced to endure opioid withdrawal after birth. Apparently that’s too hard. The “solution” the researchers offer is to force opioid addicted the mothers — the same people who made their children deathly ill because they couldn’t pry themselves from the grip of addiction — to provide the highly specialized care their babies need despite the fact that they themselves are still recovering from childbirth.
It sounds like an particularly ghastly joke, but it isn’t.
Opioid-exposed newborns are typically cared for in neonatal intensive care units (NICUs), and standardized scoring systems, such as the modified Finnegan system, are used to quantify NAS symptoms and to adjust medications used in treatment. Paradoxically, studies have found that opioid-exposed newborns in NICUs experience more severe withdrawal, longer length of stay (LOS), and increased pharmacotherapy compared with newborns who room in. In rooming-in care, infant and mother remain together 24 hours a day unless separation is indicated for medical reasons or safety concerns. More maternal time at the infant bedside improves NAS outcomes but is harder to accomplish in a typical NICU. Neonatal intensive care units may be poor settings for newborns with NAS because of increased sensitivity to high clinical activity levels…
The excessive sensory stimuli present in a busy NICU is especially jarring for newborns withdrawing from opioids? You don’t say! We could provide one-on-one care is a quieter setting off the main NICU but that would be even more expensive.
Hey, I know how we could provide one-on-one care in a quieter setting and save money, too. Just let their addicted mothers take care of them in the privacy of their own rooms while they are recovering the the exhaustion and agony of childbirth!
While rooming-in may be effective for NAS, potential risks include unintentional suffocation, falling from an adult bed, or undertreated NAS after hospital discharge.
No fooling!
What did the authors find in their literature review?
This systematic review and meta-analysis demonstrates that rooming-in is associated with decreased need for pharmacologic treatment of NAS and shorter LOS. The results of several included studies suggest that rooming-in is associated with reduced hospital costs, but the significant heterogeneity across studies precluded quantitative analysis. Because of variable reporting, we were unable to draw formal conclusions about the role of rooming-in on other secondary outcomes of interest. The findings of 2 studies suggested that breastfeeding increases with rooming-in. There was no evidence that rooming-in for NAS was associated with a significant increase in hospital readmission. Reporting of adverse events was insufficient to draw any conclusions about an association between rooming-in and these outcomes.
In other words, the studies showed a decreased use of pharmacologic treatement that the authors interpreted to mean a decreased need for treatment and a shorter length of stay. The authors couldn’t tell if any money was saved and the study was too small to draw conclusions about adverse events.
It seems never to have occurred to the authors that the Dickensian premise of the study — that opioid addicted mothers should be employed for free to care for their suffering opioid addicted newborns so we can save money on skilled caregivers — is absolutely grotesque.
What was the impact on the mothers themselves? Surely you jest. It never occurred to anyone to check because no one cares.
Whatever happened to basic human compassion? It’s apparently less important than the drive to save money.
If the idea was to support the woman and help her learn to care for her baby, with a good safety net in place, while allowing a baby to stay in a less stressful environment than NICU, provided the baby is stable enough, that’s all great. Somehow I suspect in practice it would play out more like: “you messed that baby up, now you deal with the consequences. We’re not helping you. And DSS already has their eye on you because your baby was born addicted, so you better do everything perfectly or it will be used against you.”
Why would caring nurses want a baby to suffer with an overwhelmed mother? They wouldn’t. So they provide teaching and care and intervention intended to pick up babies who will need to go to the NICU for therapy if they develop severe withdrawal. We do this in our centre and everybody is happier. Especially the moms who get to bond with their babies (lower risk of subsequent neglect and abuse) and the babies who get a quiet, slow stimulation, high-snuggle environment. It’s not punitive, it’s part of a drive to help fledgeling families have a fighting chance when faced with so many other burdens already. Because there aren’t unlimited foster homes, and many of the foster homes out there aren’t great: even when not ideal, placement with the biological mom is often the least-bad option a child has, and so we owe it to babies to ensure they have the best bond and support, and that their moms have the best hands-on teaching, that we can possibly provide.
So it’s easy to “suspect”, but that’s no different from lactavists “suspecting” that breastfed babies are smarter/happier/more sparkly in the absence of any evidence to support.
I have a different experience: we have many women on opiods in pregnancy who delivery infants who experience NAS in our centre. Historically, these babes were admitted to NICU when their “abstinence score” rose to a certain level and were monitored there, sometimes receiving a tapering dose of morphine if need be. Then, last year, our neonatologists began a “rooming in” programme with moms of babies not at high risk of apprehension by child protection. There is no goal to shorten length of stay in our centre – all babes at risk of NAS must stay and receive “abstinence scoring” for 5 days. The moms receive a lot of nursing support (often one nurse is assigned to only two or maybe three moms and their babies for a shift), breastfeeding support if they wish, and social work support. There is lots of skin to skin and learning to know and read their babies. A lot of teaching on “how to look after a newborn”. None of this occurred when these babies were stuck in NICU under observation (with one nurse for 4 babies). Babies still receive abstinence scoring, which is done with the mom present and involved in understanding what the nurses are watching for. Often babies still end up transferred to the NICU, although usually for shorter periods. Overall the moms are happy, they’re bonding to their babies (which provides some protection against later abuse and neglect), and the babies appear to be doing very well. It’s not all kittens and kumbaya by any stretch, but it doesn’t have to be as crazy as it sounds, either.
I showed this post to the nurses on our maternity floor and they burst out laughing. One said, “You mean that same patient I can’t rouse after her methadone is taking care of her complex neonate? Who thought THAT would work?”
This idea comes across as: “Well you brought this on yourself; now you must suffer the consequences.” It’s emblematic of our society’s complete lack of compassion for people suffering with addiction.
I appreciate the idea of finding ways for moms who want to room-in with their babies to do that. I imagine a lot of the moms who are addicted during pregnancy are between a rock and a hard place and if a mom wants to room-in and her baby is stable enough I can see the benefits to trying to accommodate that request.
The issue I have is that this study is – pardon my swearing – ass-backwards when it comes to cause-and-effect. A baby who is struggling hard with withdrawal symptoms is in no condition to be rooming-in and likely needs more support than a postpartum woman without medical training can give and is already in the NICU. On the other hand, a baby who is handling withdrawal well and who has a mom who is recovering from delivery well may be much happier rooming-in.
To me, it’s as dumb as a study declaring “Premature babies who room in with their mothers have lower rates of negative outcomes!” No shit – rooming-in would preferentially select the healthiest preemies and the least beat-up mothers so it’s little wonder those babies do best.
This was my immediate reaction as well. “Well, of course…the babies who are well enough to stay with their moms ARE going to do better. Who would’ve thunk?” If a baby is sick enough with withdrawal to have to go to the NICU, naturally they’re going to have a longer stay. For goodness sake.
I can’t believe a study like this might be directing policy decisions, but I’m afraid the dollar signs might be too much for some administrator to resist.
I feel the need to comment on this because I am a pediatrician, and I trained at an institution that has been paramount in this discussion of rooming in, and there seems to be a lot of misconceptions in the above review by Dr Tuteur.
First of all, the language used in this post is extremely inflammatory in that most of these women are, key word, recovering addicts who are in programs and have frequent drug tests. They all have social work involved and if there are any concerns DCF is involved immediately. The vast majority are not losing custody and will be the active parents of these children, so involving them in their care is paramount and allows providers to have a sense of how they will handle having a newborn at home. When there is a woman actively using or with recent drug use, there is usually much less parental involvement allowed (limited visiting hours, supervised visits), and nurses take over the care of those infants.
Second, almost no institution whisks a baby away to a NICU immediately after birth for NAS anymore, as most babies don’t show signs for a few days. They stay in the nursery with mom until they become symptomatic and need to be transferred out. In these studies referenced, these babies are no longer transferred out to the NICU but to the pediatric floor where they get their own room and where they are still under the care of nurses and physicians, and under monitoring. Women, once discharged from the hospital can then can sleep in the room with their infant rather than only being allowed to visit during specific hours in the NICU. Remember these are new mothers and many of them WANT to be with their infant, just like you would want to be with your brand new baby. Also, women are not forced to stay and care for their newborns. If a mother wants to leave she is allowed, just as she would be allowed if she had an older child hospitalized.
Finally, the AAP guidelines on NAS from 2012 make clear that non-pharmacological interventions are the first line for NAS treatment and include providing a dark room with little stimulation, and swaddling. By moving a baby out of the NICU and onto the pediatric floor, they are receiving that specific medical care without compromising the care of around the clock nursing staff and physicians.
The issue that bothers me most is that no one asked the mothers what they wanted or how they felt about mandated rooming in. The idea that mothers and babies must be together 24/7 from the first moments is not supported by science and reflects the value judgments of lactivists and others who seek to take choice away from women. The problem is made more obvious by the fact that no one seems to have asked him or herself whether it was a appropriate to try to save money by refusing to let these women rest. Why can’t women choose to rest in the hospital? Why do we have such unreasonable expectations for new mothers? It’s wrong and it’s anti-feminist.
I am sure the institution you trained in was exemplary and did an excellent job of promoting mother-infant interactions once the infant was in the pediatrics floor – and that’s a great step forward in compassionate care for the entire family unit.
That’s not what the study above discussed, however.
The review protocol states that the studies included in the Cochrane Revew included women on replacement therapy – but also included women who were using illegal drugs or prescribed opioids in harmful ways.
The review protocol also states that they are using rooming-in to mean 24 hour a day during the postpartum hospital stay. Now, I am not opposed by any means to rooming-in for mothers who want to stay with their infants assuming that the infant is stable and doing well in a standard hospital room. My issue is that the study cannot separate the pre-existing severity of the infant’s illness with the process of rooming-in. Presumably, an infant who is hyperthermic, vomiting multiple times per feedings, showing myoclonic jerks and trembling severely while undisturbed is more likely to be in the NICU as well as need more medical interventions than a baby who is a bit mottled, has a stuffy nose, shows some retractions and fast breathing, but is sleeping for 2 hours at a whack and can be calmed down in 5 minutes.
Putting a baby in a peds room will increase family-baby time and is a an excellent care plan. Darkened, quiet rooms – including modified alarms – along with swaddling are quite achievable within a NICU setting; I spent the better part of two months in rooms like that with my micro-preemie. The tricky bit for term babies born with narcotics addiction I imagine is dealing with the screaming of the other babies – so perhaps the mites who are too ill to room in (or whose mothers don’t want to room in or can’t room in) will need to be in individual rooms within the NICU or in bays built with acoustic dampening in mind.
Did they seriously just mention increasing breastfeeding rates? In babies born addicted to drugs? Do these authors seriously want babies to be breastfed so damn much that they think leaving them in the care of their addicted mothers who will then be pressured to breastfeed them as part of their “care giving” and then discharging them too early to go home and breastfeed some more is a GOOD idea? WHAT THE ACTUAL FUCK??????? ARE THESE RESEARCHERS OUT OF THEIR EVER- LOVING MINDS? I know the premise wasn’t increasing breastfeeding rates, but they did say it, and the hospitals that make the biggest deal about rooming in are usually baby-friendly, so you know it’s there. Just when I thought America couldn’t possibly be more fucked up than it is at this moment, I’m reminded there is always room to fall.
I got told to breastfeed my twins when one of them was in the NICU with breathing problems and I was slamming Percocet post-c-section. I looked up Percocet on my phone and found that it’s not good for breastfeeding because it’s an opiate that causes RESPIRATORY DEPRESSION in newborns. Respiratory depression. When my preemie was already in the NICU for respiratory problems.
After that I just nodded and smiled when the NICU doctors said breastfeeding was “so important,” and stuck to 100% formula until I was off the Percocet. “Nod, smile, go fuck yourself, doctor!”
This level of fanaticism around breastfeeding makes intelligent people distrust their doctors. Is that really where you want to go, doctors? Is breastfeeding THAT important? That’s a rhetorical question…
I’m so sorry that all happened to you. What a steaming pile of crap. Kind of reminds me of the LCs talking about ways to increase my milk supply after my son’s readmission. They mentioned domperidone and one other medicine, which they said could cause emotional side effects, so if I had a history of depression, anxiety, or severe PMS, I should be careful. I’d just had my baby readmitted for starving–did she think I needed drugs that would make me more emotional just so I could breastfeed? Thankfully I knew enough to decline everything stronger than fenugreek…but if I hadn’t, I have no doubt they’d have further risked both our health to keep us breastfeeding. Sigh…
Domperidone? Holy crap. Domperidone can kill you–sudden cardiac death–which is why it’s been illegal in the US for several years now. How scary that they tried to push that on you. I’m so glad you resisted.
My LC knew I had a family history of diabetes, and told me all about how BFing prevented diabetes. She DIDN’T tell me, however, that the fenugreek she’d told me to take in copious amounts can screw with insulin levels.
I didn’t know that either, Shawna. I hope you’re okay after that. Pretty sure Dr. Amy just wrote a post debunking breastfeeding reducing maternal diabetes too. Will they never learn???
How are the infants who are rooming in being accessed accurately for a Finnegan score in the first place?
The average mom – regardless of addiction status – is not going to know what a myoclonic jerk, excoriation or hyperactive Moro reflex looks like.
The test is supposed to be based on an hourly observation as well which is going to be hard to pull off for a nurse with a standard postpartum rooming in client load – so my assumption is that the test is not being done correctly.
The Finnegan score has a lot of useless information, like how many times a baby sneezes. There are a few new scoring regimens that have been published in the past few years, with one being the “ESC” model which stands for eat, sleep, console. Basically looks at if the infant is able to
E – Eat (is an infant is able to eat 1 or more ounce per feeding)
S – Sleeping (sleep for an hour or longer undisturbed)
C – Console (Be consoled in 10 minutes or less.)
But I should note, the infants are still being scored/evaluated, just usually on a different scale
The modified Finnegan score does not include how many times a baby sneezes. The scoring guide states that more than 3 sneezes in the observation period should be scored as 1 point; less than that is 0 points.
To be clearer: the modified Finnegan score seems to be well written to protect an infant’s central nervous system and to help nurses score infants on issues common to babies dealing with narcotics withdrawal. Yes, it requires training to use, but it collects information of direct use to clinicians.
The ESC system is easy for non-trained users to use – but it’s lacking any specificity to narcotics withdrawal symptoms.
(med student here) I apologize if I am misunderstanding your point but I am genuinely curious if it is reasonable to expect women who just gave birth to clinically assess their newborn q1hr (or even q 3hr)? I read what you said above and it makes sense that for motivated moms who are interested in caring for their newborns should have the opportunity (immediately postpartum or on the peds floor) but having the baseline expectation that they should/must when they are themselves a patient, specifically to save money, seems like terrible patient care to me.
That’s because it is.
Signed, a mom who, courtesy of a so-called baby-friendly hospital, was expected to care for her newborn while hallucinating due to a med interaction, bedbound courtesy of a catheter (so no, I couldn’t get baby in or out of his crib), and having just had a C-section a few hours prior.
(Mind you, at least neither baby nor I were going through opioid withdrawal at the time, though I suspect that that wouldn’t have made much of a difference to the idiots who’d set that policy.)
Every time you tell this story I become enraged all over again.
Just because baby is rooming in with mom doesn’t mean baby doesn’t have a nurse looking after them. Most of our neonatal abstinence babies room in at our hospital, under close surveillance with an experienced nurse assigned to two or three new moms and their babies… a ratio not that different for what the baby would have in NICU. Rooming in doesn’t mean the mom does the vital signs and assessments and Neonatal Abstinence scoring! Just that mom and babe are kept together most of the time.
I suppose I was imagining trying to fit the concept into the way our institution is organized. I don’t think our nurses could manage up to q2hr checks on top of normal care with their patient load, hence the relying on parental observation. Our nas babies who don’t need full nicu care usually spend their time in the nursery which is staffed by a few nurses for all babies that pass through. With increased staffing and decreased ratios, I can see the feasibility (and the increased support you describe above sounds great for women who desire it) but I still think its inappropriate to have a policy that expects patients to take care of other patients unless they expressly wish to do so.
Would state laws that automatically remove babies born addicted from their mothers’ care allow this approach? Would the women have to provide free medical care and then lose custody immediately after? Did the study even look into whether the babies suffered more without professional care and medicine? This is so cruel.
I don’t know of any jurisdictions that automatically remove babies born addicted. There aren’t enough foster homes to go around for that many kids. Women aren’t providing free “medical care” – the nurses still observe these babies (very, very closely), but the mother is able to be more involved and to attach to this small human… which is critical, because at home, she’s going to be all this baby has. And what’s more frightening than a stable addict rooming in with and then taking her baby home… is a stable addict who probably has a history of coping problems taking her baby directly home from NICU and having no idea how to care for that baby.
OT: European infant formula developers, Jennewein Biotechnologie, was granted EU novel food status for its 2′-fucosyllactose human milk oligosaccharide (HMO) today. This brings us one step closer to having HMOs included in all commercial infant formulas, thus bringing formula even closer to breast milk 😛
Why limit it to new mothers, what about all those other lazy women in the hospital?! The ones lying in bed, doing nothing, just because they had a stroke, or appendicitis, or a heart transplant. Shame them into taking care of the other patients! Make any family visiting them help out too. It would save so much money!
It takes a village, right?!
Only female family members, though. Men shouldn’t have to do it.
This sounds like a plan that couldn’t possibly go wrong.
This is just a shit situation all around. Mom uses, without treatment, while pregnant, and baby is born addicted. Mom is treated with Methadone while pregnant, and baby is born addicted. It’s as if once she hits the prenatal period and is using (any/either substance), the baby is screwed. It suffers. As for proposed solutions, I imagine they should really be aimed at the “before” variables.
Oh, and this is just a dumb idea.
If mothers have the babies in their rooms, then who is going to watch the baby when she goes out to the parking lot to shoot up with the father?
Seriously I know of a recent local NAS case where the mother went out to the parking lot to shoot up heroin with the father while she was in recovery.
She’s the one you want in charge?
For babies with fairly mild finnegan scores maybe this idea might work, but I still think it’s a crap idea! I’m glad I read this because I was beginning to think I was the only one who thought it was cruel to a fresh postpartum mother to make her child’s recovery her responsibility. What if she’s unable to keep the baby’s scores low enough? Will that be used against her as a sign she’s an unfit parent? How much suffering should the baby endure to save money on their own recovery?
I work where we already do this – of course the NICU babies stay longer. Only the ones that require pharmacotherapy go there. Just saw a finnegan score of 30 for the first time in my career so the whole subject has me fairly up in arms right now.
Sending the baby to the nursery or not breastfeeding will become evidence that she’s unfit …
Unfortunately yes- woo believing staff see that as evidence the mother isn’t bonded enough.
We have moms who are judged when their baby is in the NICU for withdrawal and they return to work, not spending every hour of every day in the NICU. Not working often means no money, no money means homelessness for these moms. But yes let’s judge the mom for keeping her job, paying her bills, and providing a secure home. Everyone knows a REAL mom wouldn’t want to work if she has a partner! (What? Some women enjoy working? No they aren’t real mothers how dare they)
And, of course, all moms have partners. Let’s not forget that!
/sarcasm, to state the obvious
(An acquaintance delivered at a hospital a couple of years back at which only the father of the baby was allowed to stay overnight with mom and baby. No, mom’s mom wasn’t an acceptable care partner, even if dad was IN THE MILITARY AND DEPLOYED AT THE TIME. It didn’t take a rocket scientist to see the MANY issues with that policy…)
Partnerless mothers? They don’t get counted as people do they? Yeah I’m a bit burned out on dealing with the assumptions
I recall reading a blog post, I think from a neonatology resident or similar, about being horrified that somebody in the hospital called CPS and tried to get emergency custody from a mother who lived hours away, had other kids, was a single, impoverished mom, and couldn’t be at the hospital very frequently, though did call multiple times a day. I can’t recall the resolution of that, though I want to say the mom wound up having to fight to be able to take her baby home once the baby was healthy enough to be discharged.
Man, I thought this was going to be one of Dr. Tuteur’s satire pieces. Very bummed to discover that this is not the case, and serious researchers are seriously proposing this measure as a Good Thing.
I thought so too. Who in their right mind thinks a woman who has recently been or is still on opiods AND just given birth is liable to be good at this parenting thing for a healthy child, much less one going through his or her own dts?
Wow, judge much? Most women who use opioids love their kids desperately and want to be good moms. Rooming in is most successful for motivated, stable women, most of whom are on methadone as part of their addiction management.
Perhaps I phrased that poorly. It’s not just being on opiods, it’s also the aftermath of childbirth. Not all of us are walking out of the hospital 2 hours later with ease.
I’ve never taken methodone, but I have had an opiod and it made me loopy af. Childbirth also made me loopy af. I do not remember my son’s first night because I was so out of it. I don’t even remember nursing him, though my husband says I did. It was -not- safe for me to take care of my child that day.
I’m sorry if I did seem judgemental; it was not my intent. I just know that in my case, it’d have been a bad idea.
am I the only one who at first read the headline as saying they were forcing the mothers to provide the babies with opioids?
Well if they want them to breastfeed that’s kind of what would happen…
I presume these mothers are not ones actively using drugs but rather ones stably on methadone. NAS doesn’t manifest until 24-96 hours after birth. So basically what we are asking of these women is no different that what we are already forcing women to do, except for the fact that their babies are likely to be more needy than average starting 1-4 days after birth.
To my mind the problem is not that we pressure these women to room in, but that we pressure ANY woman to room in. Some women (whether with chemical use disorders or not) may be reasonably well-recovered a few days after birth; many will not be.
Also
“Paradoxically, studies have found that opioid-exposed newborns in NICUs experience more severe withdrawal, longer length of stay (LOS), and increased pharmacotherapy compared with newborns who room in”
Unless this was prospective and intent-to-treat, this just says to me that the sicker newborns were sent to the ICU, and the less severe ones roomed in.
Like a disturbing number of studies on rooming-in, the real issue becomes clear if you insert something even more obvious in the category of _______ newborns.
“Studies have found that preemies who are treated in NICU have higher negative outcomes….” or “Studies have found that infants with cardiac defects who are treated in the NICU have higher negative outcomes.”
The difference in the groups isn’t NICU vs. rooming-in; it’s severity of illness in the newborn.
The very first thought I had when I read the ‘potential risks’ was a horrible one, and it was that they want the addicted mums to be responsible for the deaths of the babies. Save money on child care, toss the responsibility for bad outcomes onto the mums.
I suppose a dead baby doesn’t cost much. I had this thought as well.
Well, they don’t really want to provide formula for newborns who need/want it and a nursery for moms to use, why should they want to provide special care for addicted newborns?
Typo alert: the paragraph after the second block quote says one of the symptoms of NAS is “swearing.”
They probably would if they could, but they can’t.
Thanks! Fixed it.
Talking to yourself?
Drug-addicted mothers? That’s who should be caring for drug-addicted babies? Women who obviously know how to access illegal opiates, who might have some in their purse or might get a friend to bring some to the hospital, and thus could fall unconscious or die at, like, any moment? WTF? What lunatic thinks that’s a good idea?
It doesn’t matter if they’re unconscious or dead, as long as they’re boosting the hospital’s EBF stats! Opiate-laced milk is no reason to resort to formula.
My first thought was that perhaps the rooming-in infants are experiencing less withdrawal simply because they are still getting some opiates from breast milk. I hope they controlled for that possibility.