A Clinical Outcome Study of Meth Exposed Infants

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A Clinical Outcome Study of Meth Exposed Infants

• Rizwan Z, Shah, M.D., FAAP
• Blank Childrens Hospital
• Des Moines, Iowa, USA

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CAIRE Program(Children and Infants Recovery
Efforts)

• CAIRE Program provides assessment and service
  coordination for drug exposed children.
• Started in 1989, CAIRE Program evaluated the
  first meth exposed child in 1993.
• Program serves children in a 100 mile radius area
  around Des Moines, Iowa.
• Consultation services are available to community
  agencies throughout the state of Iowa.
• Clinic is staffed by Pediatrician, nurse
  practitioner, two nurses, two master level social
  workers, Program Manager, Psychological and
  Psychiatric Consultative Services.

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Referring Agencies

• Department of Human Services
• Substance Abuse Treatment Programs
• School System
• Practicing Physicians
• Families - both biologic and adoptive
• Juvenile Court

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Assessment Protocol

• Intake
• Clinic nurse gathers info regarding child and
  family.
• Determines how soon child should be examined and
  advises caregiver-social worker about what
  information to bring to clinic appointment.

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First Visit Evaluation

• History
• History of drug exposure
• Prenatal and neonatal history
• Past medical history
• A. Feeding, sleep and social history
• B. Areas of concern
• C. What assessment/service are in place
• Psychosocial History

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Assessment

• Complete Physical Exam
• Growth Assessment
• Dysmorphology Exam
• Neuromuscular Exam
• Neurobehavioral Assessment
• Developmental Screening

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Conclusion and Recommendations

• Identify areas of concern
• Identify community resources for interventions
• Parent/caregiver education
• Follow up recommendations

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Follow-up Assessment

• Ages newborn to 6 months - at one-two month
  intervals.
• Ages 6 months to 18 months - at three month
  intervals.
• Ages 18 months to 5 years - 6 months to 12 months
  intervals
• 5 years to 10 years - once a year.

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PREGNANCY AND INFANT OUTCOME STUDY

• Population Drug exposed infants evaluated at
  Blank Childrens Hospital.
• Population Characteristics
• Meth exposed 61
• Cocaine
  36
• Meth/cocaine exposed 12

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MATERNAL DATA

• Substance Abuse Pattern
• Women who use meth/cocaine in the first trimester
  are more likely to use during the third trimester
• Nicotine use is universal among drug using
  pregnant women.
• Marijuana and alcohol are secondary drugs, used
  in 60 of the group.

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PREGNANCY OUTCOME

• Meth group
  Cocaine group Meth/Cocaine
• No prenatal care 40 22.2 40
• Acute illness 34.5 44.4
  37.5
• Nutritional Problems 16.7 18.8
  71.4
• Pre-term birth 25 24
  30

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INFANT OUTCOME

• Growth Meth exposed Cocaine exposed
  Meth/Cocaine
• Weightlt10 19 30
  33
• Head sizelt10 10 20
  40
• Height value not effected in these groups.

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INDICATORS OF CHILD WELL BEING

• Meth only
  Cocaine Meth/Cocaine
• Accidents 19.7 8.3 25
• Feeding problems 34.4 9.4
  33.3
• Sleep problems 39.3 44.4
  50
• Neuro problems 21.3 19.4
  16.7
• Behavior Problems 57.4 63.9
  75

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DEVELOPMENTAL OUTCOME

• Dev delays Meth exposed Cocaine exposed
  Cocaine/Meth
• Gross Motor 11.7 5.6
  25.7
• Fine Motor 9.6 9.4
  16.7
• Language 6.7 14.3
  16.7
• Social 4.9 4.5
  11.1
• Delay in any one
• domain 41 41
  66

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Symptoms of Meth Exposed Infants and Children (I)

• NB to 4 weeks (Dopamine Depletion Syndrome)
• Lethargic-Excessive Sleep Period
• Poor Suck and Swallow Coordination
• Sleep apnea
• Poor habituation

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Symptoms of Meth Expose Infants and Children (II)

• Four Weeks to Four Month Age
• Symptoms of CNS immaturity - Effects on motor
  development
• Sensory Integration Problems - Tactile,
  defensive, texture issues
• Neurobehavioral Symptoms - Interaction Social
  development

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Symptoms of Meth Exposed Infants and Children
(III)

• Six Months to Eighteen Months
• The Honeymoon Phase
• Symptom Free Period

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Symptoms of Meth Exposed Infants and Children (IV)

• Eighteen Months to Five Years
• Sensory Integration Deficit (Same as 2)
• Less Focused Attention
• Easily Distracted
• Poor Anger Management
• Aggressive Outbursts