At MassGeneral Hospital for Children, Leslie Kerzner, MD, is a leader in improving the care of newborns exposed during pregnancy to opioid drugs such as heroin and the maintenance medications used to treat addiction to opioids.
Her team cares for infants in the days following their birth—when the babies must be carefully weaned from the drugs. As associate director of the MGHfC Special Care Nursery, her goal is to lessen withdrawal symptoms and to protect newborns from a seizure, which could have consequences on their rapidly growing brains.
Dr. Kerzner also meets with each mother during her pregnancy to share with them what to expect. And she helps them through the harrowing experience of watching their newborns experience withdrawal after they are born.
Mass General’s Addiction Initiative
“One of the things I say to all of the mothers is, ‘At Mass General, we are non-judgmental. We are here to support you and your baby,’ ” Dr. Kerzner says. “My message to them is, ‘Let’s move from here forward.’ ”
Dr. Kerzner’s work reflects Mass General’s broader efforts to improve care for people who have substance use disorders. Launched in 2014, Mass General’s Substance Use Disorders (SUDs) Initiative has created addiction consult teams to help emergency room patients who have overdosed. It has also worked with physicians to ensure careful prescribing of opioids and increased the use of coaches to help patients recover from addiction.
Opioids and Pregnancy
Between 2000 and 2012 there was a five-fold increase in the number of babies born with opioid withdrawal, according to the National Institute on Drug Abuse. Opioid abuse includes the illegal drug heroin, misuse of prescriptions, such as oxycodone or the maintenance medication methadone that is used to treat addiction.
Yearly, Dr. Kerzner monitors about 40 newborns exposed to opioids. A little more than half require prolonged hospital treatment.
Brandi Connor and her partner, Eddie Johnson, first met Dr. Kerzner during Brandi’s pregnancy. Brandi was a patient at Mass General Charlestown Health Center and was referred to Dr. Kerzner. She had quit heroin a few years earlier, but was on a medication prescribed to manage her urges.
Fourteen years before, Brandi had been through a pregnancy, but she remembers that time doing everything naturally and by the books. “My situation was 100 percent different,” she explains. “I was nervous for my baby. I didn’t want to hurt a baby.”
An Agonizing Choice
At Dr. Kerzner’s advice, Brandi decided to continue using suboxone, a new medication she was taking to manage her urges during pregnancy. Dr. Kerzner told Brandi that stopping could result in a miscarriage or other complications.
It was an agonizing choice because Brandi learned suboxone could cause her newborn to experience withdrawal.
“I felt a lot better after the appointment,” Brandi says. “Mass General is unbelievable.”
“I felt a lot better after the appointment,” Brandi says, adding she experiences anxiety. “Mass General is unbelievable. Really, it’s me and Eddie. We don’t have family. It was nice to have a support system.”
During withdrawal some infants cry and shake uncontrollably. They also breathe fast, sweat and develop a fever. Sometimes they cannot feed well.
A newborn exposed to opioids requires a minimal hospital stay of four days, two days longer than a typical birth. Some infants will require hospital care for six weeks.
A Boy Full of Life
Dr. Kerzner and her team use neonatal morphine to ease symptoms. The team standardized scoring of a baby’s vital signs so that the withdrawal progress could be consistently noted and tracked.
On Oct. 31, 2015, after an all-night labor, Brandi and Eddie welcomed Declan, a baby boy, into their family. At 8 pounds and 3 ounces, he was a healthy weight. He did not experience many withdrawal symptoms but did go to the Special Care Nursery. There, he mostly slept.
These days, Brandi describes her blond-haired, little boy as a “very independent, goofball,” who is her “sidekick.”
“I love seeing Declan’s reaction to what is new in his life,” she says. “My joy is him.”
Monitoring Early Development
Philanthropic funding could help Dr. Kerzner support more families, educate healthcare professionals and conduct related research.
For at least two years after their birth, Dr. Kerzner follows such babies in the Newborn Developmental Follow-Up Clinic. The clinic which Dr. Kerzner co-directs with Melissa Woythaler, DO, was started by a gift from Barrie and Kevin Landry. Like the Special Care Nursery, the clinic cares for babies exposed to opioids as well as children not exposed to these substances but who are born extremely premature or with other high risk conditions.
With therapists, Dr. Kerzner tracks the babies’ development and gives parents guidance and support. She knows mothers are at a high risk of relapsing into substance use.
Additional philanthropic funding could help Dr. Kerzner support more families, educate healthcare professionals and conduct related research.
“The data does not show long-term effects from opioid exposure during pregnancy,” Dr. Kerzner says, “But I would like to explore that research—so we can determine how effective our interventions are.”
To learn how you can support the babies and mothers Dr. Kerzner cares for, please contact us.