Fetal and Neonatal Effects of Inhalant Abuse

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Fetal and Neonatal Effects of Inhalant Abuse

• Milton Tenenbein, MD
• University of Manitoba
• Inhalant Abuse Among Children and Adolescents
• Consultation on Building an International
  Research Agenda
• Washington, DC November 7-9, 2005

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Topics

• Neonatal Acidosis
• Neonatal Withdrawal
• Fetal Solvent Syndrome

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Neonatal Acidosis
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Metabolic Acidosis

• a complication of inhalant abuse
• mechanism unclear
• renal tubular acidosis?
• increased organic acid load?

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Neonatal Metabolic Acidosis

• literature brief mention of 3 cases
• Winnipeg experience
• 22/36 newborns
• 15 transient
• 7 persistent

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Conclusions

• neonatal metabolic acidosis occurs
• severity is variable
• likely related to degree of exposure immediately
  prior to birth

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Neonatal Withdrawal
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Purpose

• To describe . . .
• neonatal withdrawal from inhalants
• its gradation by clinical scoring
• its treatment with phenobarbital

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Methods

• 4 year study
• included all offspring of inhalant abusing
  mothers
• excluded neonates with major illness
• polysubstance abuse (except alcohol)
• Finnegan Neonatal Abstinence Scoring System
• pharmacotherapy phenobarbital
• odor of inhalant abuse retrospective review

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Results
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Clinical Features

• Fulfilled Criteria for
• Pharmacotherapy Yes No
• Number 32 16
• weight (kg) mean 2.9 2.8
• range 2.0-4.1 1.8-4.2
• Gender M 20 9
• F 12 7
• Chemical Odor
• Baby 8 0
• Mother 15 6
  

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Features of Neonatal Inhalant Withdrawal

• excessive and high pitched cry
• sleeplessness
• tremors
• hypertonia
• poor feeding

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Pharmacotherapy

• Number of Newborns 28
• Age at Onset of Therapy 27.1 hr
• Duration of Therapy (n27) 5.8 days
• Efficacy of Therapy (n27)
• yes 17
• no 7
• borderline 3
• one received a loading dose
  but no maintenance therapy

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Conclusions

• Neonatal withdrawal from inhalants occurs
• Finnegan scoring is useful for its gradation
• Inhalant odor in baby or mother is a marker
• Phenobarbital therapy seems to be worthwhile

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Fetal Solvent Syndrome
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Background

• several descriptive reports suggest the existence
  of the Fetal Solvent Syndrome
• the phenotype is virtually identical to the Fetal
  Alcohol Syndrome

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Purpose

• to test whether exposure to inhalants during
  pregnancy produces infants with the Fetal
  Solvent Syndrome

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Methods

• case control design
• cases (3-6 years old)
• 12 infants exposed to inhalants only
• 15 infants exposed to inhalants alcohol
• controls
• 27 age and gender matched infants
• blinded dysmorphologist

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Results

• 10/27 were similar to FAS
• all 10 were exposed to inhalants alcohol
• no FAS in the 12 inhalants only group

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Conclusions

• Our data do not support the existence of a
  fetal solvent syndrome physical phenotype. The
  observed dysmorphic features is likely
  attributable to alcohol exposure in utero.

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Conclusions

• Neonatal acidosis occurs
• Neonatal withdrawal occurs
• Fetal Solvent Syndrome is not supported