Geraldine S. Wilson

Follow-up of methadone-treated and untreated narcotic-dependent women and their infants: Health, developmental, and social implications

This study compares the first years health, neurodevelopmental status, and environment of infants of drug-dependent mothers attending methadone programs during pregnancy with those of drug-dependent mothers not enrolled in treatment programs (untreated). Both groups were also compared with drug-free controls. During pregnancy, the use of heroin and other psychoactive drugs was common among patients using methadone. Neonatal abstinence syndrome was of longest duration in the methadone group. Infants of both drug groups were smaller at birth, had more neonatal infections, and were viewed as more difficult to care for after nursery discharge than were those of drug-free mothers. On follow-up, mean developmental scores were within the normal range for all groups. The untreated drug-dependent group was more hypertonic than the methadone group, and a high rate of transient or minor motor disturbances and poor attention span was found in both drug groups. The behavior of methadone-treated women during pregnancy and the postnatal period closely resembled that of drug-free controls, and contrasted with untreated drug-dependent women. Methadone-treated women had a high degree of compliance with antepartum care, and 80% continued in the role of parent through the first year. Further investigation will determine whether the consistency of parenting will continue and whether it will enhance the development of their children.

Congenital rubella encephalitis: Course and early sequelae†

Neurological abnormalities were noted at some time between birth and 18 months of age in 81 of 100 patients with congenital rubella infection. These included lethargy, full fontanel, irritability, and increased concentration of protein and persistence of virus in the cerebrospinal fluid. Of the 64 survivors 44 had a wide range of neurological abnormalities at 18 months of age including motor paresis, restlessness, motor mannerisms, and developmental delay. Retardation in growth, particularly of the head, was still manifest at 18 months. Pathological changes in central nervous system structures included leptomeningitis, vasculitis, and multifocal areas of parenchymal necrosis and perivascular calcification.

Clinical Studies of Infants and Children Exposed Prenatally to Heroin

For almost a century, the newborn drug withdrawal syndrome has been a predictable consequence of opiate dependency in pregnant women.’ Over the ensuing years this once life-threatening condition has been well described and effectively treated.2.’ In recent years, the increasing popularity of recreational drug use and abuse by all segments of society has led to an interest in possible long-term effects on children exposed prenatally to these drugs. Follow-up studies involving children exposed prenatally to heroin have been particularly difficult to interpret because of the variability inherent in the addicts’ life style as well as limitations in study design. Samples have been small and poorly defined, and comparison groups were either absent or failed to match for important life-style characteristics. Data was often based solely on interview, and test batteries did not utilize well-standardized instruments. Early studies were largely descriptive in nature. In the first such study, half of thirteen children of heroin-addicted mothers who were followed through at least one year of age showed difficulty in regulating their behavior, but were otherwise developmentally n0rma1.~ A sequel to this preliminary study compared the neurodevelopmental and behavioral function of twenty-two preschool heroin-exposed children with that of controls.’ Controls were children at environmental risk (i.e., raised by drug-dependent parent but not exposed in utero), children with other nondrug-related perinatal risk factors, and children of similar sociodemographic background without specific risk factors. By parental report heroin-exposed children had more adjustment problems than controls, but they did not differ on objective measures of attention, activity, or other observed behavior. Lower performance on tasks involving perception, organization and short-term memory suggested that heroin-exposed children might be at risk for later school problems. Olofsson has reported the outcome at one to ten years of 72 children exposed in utero to a variety of drugs (heroin, methadone or tranquillizers)? Based on screening tests and interview data, he reported impaired psychomotor development in 21 percent of the sample and behavioral abnormalities (lack of concentration, hyperactivity, aggressiveness and lack of social inhibition) in 50 percent. He linked psychomotor deficits with deprivation.

Children of Battered Women: Developmental and Learning Profiles

Children in battered womens shelters have been shown to have more behavior problems than their peers but limited information is available about their development. A pilot survey was undertaken to determine the prevalence of developmental or academic problems in children of residents of a battered womens shelter. Demographic data, medical and school histories and responses to standardized developmental or behavioral surveys were obtained from 39 mothers of 76 children. Two-thirds of the children were victims of abuse. On the Minnesota Child Development Inventory, the mean General Developmental Quotient (DQ) of 28 preschool children was 98; however, 39% had developmental delays by test criteria. Of 46 school-aged children, 21 (46%) had evidence of academic problems, including grade repetition, failing grades and need for special educational services. On the Louisville Behavior Checklist, 75% of 48 children had behavior problems. Children in a battered womens shelter are likely to experience academic and behavioral problems; however, further study is needed to elucidate etiological factors.

Fetal and postnatal growth of children born to narcotic-dependent women

We studied the effect of heroin and methadone on birth length and 3-year stature of children of untreated heroin addicts (n = 22), women receiving methadone maintenance therapy (95% were polydrug users) (n = 21), and a drug-free comparison group (n = 28), after adjustment for biologic, demographic, and health variables. The mean birth lengths of both groups of drug-exposed infants were significantly below that of a comparison group; however, group means were similar after adjustment for sex, race, prenatal care, pregnancy weight gain, obstetrical risk, maternal education, and smoking. At 3 years of age the mean height was comparable for all groups. When adjusted for birth length, parental height, and smoking, the methadone group was significantly shorter than children exposed to heroin in utero, and the comparison group assumed an intermediate position. These data indicate that the effect of heroin and methadone on intrauterine growth cannot be differentiated from that of associated factors, and that postnatal growth of children exposed to narcotics during pregnancy is no more impaired than that of a high-risk comparison group. Children of all three groups deserve continued observation and efforts to improve their environment in order that their full potential might be achieved.

Early neurodevelopmental outcome of low birth weight infants surviving neonatal intraventricular hemorrhage

Neonatal intraventricular hemorrhage has emerged äs one of the most important and frequently encountered lesions in the central nervous System of the prematurely born infant [1]. Intraventricular hemorrhage is known to contribute significantly to neonatal mortality and morbidity. However, information regarding its effects on the long-term outcome of survivors is limited. This report describes the early neurodevelopmental Status of twenty-eight low birth weight infants surviving symptomatic neonatal intraventricular hemorrhage documented by computerized tomography and relates outcome to gestational age and grade of hemorrhage based on severity and location [2].

The health and educational status of adolescents with congenital rubella syndrome.

As part of a longitudinal study of children with congenital rubella syndrome, 53 adolescents between 16 and 18 years of age were surveyed to determine their health and educational status. The findings were compared with those at the 18‐months evaluation. At 16 to 18 years neurosensory impairments, cerebral dysfunction and organic behaviour syndromes were predominant, but the majority of children had multiple handicaps. A higher proportion had hearing loss. Although all the hearing‐impaired children were begun in oral‐based educational programs, 90 per cent of those with severe to profound hearing‐loss diagnosed before the age of 18 months had changed to total or manual communication. Those with mild to moderate hearing‐loss diagnosed after 18 months primarily communicate orally. The educational implications of these findings are discussed.

An exploratory study of the structure and validity of pediatric examination of educational readiness (PEER) factors

The Pediatric Examination of Educational Readiness (PEER) is an assessment instrument specifically designed for use by pediatricians in assessing the development of preschool children. The present study investigated the psychometric properties of the PEER. Specifically, factor analyses of items from the Developmental Attainment and Associated Observation components of the test were performed. The PEER was administered to 69 preschool children. Three major factors were identified as making up the Developmental Attainment portion of the test: perceptual-motor, verbal-cognitive, and gross motor. The Associated Observations component was found to be composed of only one factor, attention. Childrens performance on only two of these four factors was associated with their performance on the McCarthy Scales, the Woodcock-Johnson skills cluster, and the Minnesota Child Development Inventory. Discussion focused on the validity and utility of the PEER.

1161 A CONTROLLED STUDY: THE DEVELOPMENT OF INFANTS BORN TO HEROIN-DEPENDENT AND METHADONE-MAINTAINED WOMEN

As part of a longitudinal study, the development of 25 infants born to untreated heroin-addicted women and 23 infants born to methadone-maintained women was studied from birth through 1 year of age. 31 infants of women matched for time of onset of prenatal care, race, age, and marital and socioeconomic status served as controls. Heroin infants were more hypertonic (p<.005) than methadone infants or controls, while methadone infants had poorer fine (p<.05) and gross motor coordination (p<.01) than other groups. Gesell adaptive scores were lower for heroin and methadone infants at 3, 6, and 12 months (p<.05), and Gesell language and personal-social scores were lower for drug infants (p<.05) through 6 months. The mean Bayley Mental Development Index at 9 months was 96.91 (SD± 18.69) for heroin infants, 97.25 (SD± 15.74) for methadone infants, and 107.03 (SD± 14.16) for controls (p<.05). The mean Bayley Psychomotor Development Index at 9 months was 91.87 (SD± 20.39) for heroin infants, 85.85 (SD± 12.83) for methadone infants, and 97.93 (SD± 10.9) for controls (p<.05). 1 heroin infant is hydrocephalic and severely impaired, and another has the features of the fetal alcohol syndrome. Both heroin and methadone mothers used multiple other drugs throughout pregnancy. 45% of drug infants were in foster or adoptive care by 1 year; 93% had left the newborn nursery with their biologic mothers.

EFFECTS OF PASSIVE SMOKING ON CHILDREN'S BEHAVIORAL AND COGNITIVE DEVELOPMENT

Seventy children were evaluated at the mean age of 4.7 years as part of a longitudinal study of full term infants born to cigarette smokers and to non-smokers. They were enrolled at birth. Evaluation included a PEER [Pediatric Examination of Education Readiness]: (score: 1=no concern, 2=equivocal, 3=definite concern); McCarthy Scales, speech & learning assessment, and pulmonary function testing. Parents completed an ANSER System questionnaire: (0=definite concern, 1=equivocal, 2=no concern). The history of passive smoking was validated by measurment of cotinine in urine and saliva of the children and their mothers. Significant findings are shown in the table. Multiple regression analysis was used to adjust for sex, race, SES, preschool experience and urine cotinine level.These data indicate that exposure to smoking in utero or in childhood may affect neurobehavioral function of children.