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A Clinical Outcome Study of Meth Exposed Infants

A Clinical Outcome Study of Meth Exposed Infants

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A Clinical Outcome Study of Meth Exposed Infants

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  1. A Clinical Outcome Study of Meth Exposed Infants Rizwan Z, Shah, M.D., FAAP Blank Children’s Hospital Des Moines, Iowa, USA

  2. CAIRE Program(Children and Infant’s 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.

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

  4. 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.

  5. 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

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

  7. Conclusion and Recommendations • Identify areas of concern • Identify community resources for interventions • Parent/caregiver education • Follow up recommendations

  8. 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.

  9. PREGNANCY AND INFANT OUTCOME STUDY • Population: Drug exposed infants evaluated at Blank Children’s Hospital. • Population Characteristics: Meth exposed 61 Cocaine 36 Meth/cocaine exposed 12

  10. 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.

  11. PREGNANCY OUTCOME MethgroupCocainegroupMeth/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%

  12. INFANT OUTCOME Growth:MethexposedCocaineexposedMeth/Cocaine • Weight<10% 19% 30% 33% • Head size<10% 10% 20% 40% • Height value not effected in these groups.

  13. INDICATORS OF CHILD WELL BEING MethonlyCocaineMeth/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%

  14. DEVELOPMENTAL OUTCOME Dev delaysMeth exposedCocaine exposedCocaine/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%

  15. 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

  16. 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

  17. Symptoms of Meth Exposed Infants and Children (III) Six Months to Eighteen Months: • The Honeymoon Phase • Symptom Free Period

  18. 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