Prasanna Nair

RISK FACTORS FOR DISRUPTION IN PRIMARY CAREGIVING AMONG INFANTS OF SUBSTANCE ABUSING WOMEN

OBJECTIVE To identify perinatal factors that are predictive of disruption in primary caregiving among infants of substance abusing women. METHOD A randomized longitudinal cohort study. One hundred and fifty two mother/infant dyads were assessed for evidence of disruption of primary caregiving or neglect during the first 18 months of life, defined by mothers inability to provide care. Data analyzed included neonatal characteristics, urine toxicology at delivery, maternal history of drug use, maternal depression, social support, and social and health history. RESULTS Sixty-six infants (43.4%) had disruption in their primary care during the first 18 months of their life, 86 infants (56.6%) remained in the care of their mothers. Women who were younger, were heroin users, had two or more children, had other children in foster care, and reported depressive symptoms were least likely to provide ongoing primary care for their infant. CONCLUSIONS Although all infants born to substance abusing women are at a high risk for disruption in the continuity of their primary caregiving, maternal demographic and psychosocial factors present at delivery can predict which infants are likely to experience an early disruption in their primary caregiving. Identifying these families can enable health care providers to monitor them more closely and, when appropriate, encourage support from the extended family.

Ongoing Maternal Drug Use, Parenting Attitudes, and a Home Intervention: Effects on Mother-Child Interaction at 18 Months

ABSTRACT. This prospective study examined the effects of ongoing maternal drug use, parenting attitudes, and a home-based intervention on mother-child interaction among drug-using women and their children. At 2 weeks postpartum, mothers and infants were randomly assigned to either an Intervention (n = 67) or Control (n = 64) Group. Intervention families received weekly visits until 6 months postpartum and biweekly visits from 6 to 18 months by trained lay visitors. The home intervention was designed to increase maternal empowerment and promote child development. Control families received brief monthly tracking visits. Mother-child interaction was evaluated at 18 months through observation of play. Mothers who continued to use cocaine and/or heroin had lower competence scores (p < .05); poor parenting attitude was also associated with lower competence scores during mother-child interaction (p < .05). Although the intervention had no measured effect, ongoing maternal drug use and poor parenting attitudes were associated with less optimal maternal behavior during mother-child interaction.

Respiratory syncytial virus illnesses in human immunodeficiency virus- and noninfected children.

Respiratory syncytial virus (RSV) lower respiratory tract and febrile upper respiratory tract illnesses were prospectively assessed in cohorts of 83 infants born to human immunodeficiency virus (HIV)- and of 48 infants born to non-HIV-infected mothers. Of the infants born to HIV-infected mothers, 18 were themselves infected with HIV, 26 were indeterminant and 39 were free from HIV. Ten RSV illnesses occurred in 8 HIV-infected, 2 illnesses in 2 indeterminant and 17 illnesses occurred in 17 non-HIV-infected children. RSV shedding was prolonged in HIV class P2- vs. non-HIV-infected children, at medians of 30 days (range, 1 to 199 days) and 6 days (range, 1 to 21 days), respectively (P = 0.02). Ribavirin and intravenous immunoglobulin failed to eradicate RSV from one child who shed virus for 199 days. Wheezing occurred in 1 of 4 vs. 9 of 10 episodes of lower respiratory tract illness in HIV-infected and non-HIV-infected children, respectively (P = 0.04). No differences were noted in duration of illness, temperature, respiratory rate or oxygen saturation between HIV- and non-HIV-infected children. Infection control and public health concerns regarding prolonged shedding of RSV in HIV-infected children must be recognized.

Invasive pneumococcal disease among infected and uninfected children of mothers with human immunodeficiency virus infection

OBJECTIVE To describe the incidence and clinical presentation of invasive pneumococcal disease in a cohort of children infected with human immunodeficiency virus (HIV) who were prospectively followed from birth, in comparison with uninfected children born to HIV-infected mothers and control children. DESIGN Prospective follow-up of a cohort recruited at birth and born to mothers with known HIV status. The person-years analysis method used the occurrence of invasive pneumococcal disease as the end point. SETTING Hospital-based clinic specializing in care of HIV-at-risk and HIV-infected children in Baltimore, Md. PARTICIPANTS Forty-one vertically HIV-infected children, 128 uninfected children born to HIV-infected mothers, and 71 control children born to mothers with negative findings for HIV but with HIV risk factors. RESULTS Among HIV-infected children, 10 episodes of invasive pneumococcal disease occurred during the first 36 months of life compared with 4 episodes among uninfected children and 1 episode among control subjects. The relative risk for HIV-infected children versus the combined uninfected and control groups was 12.6 with a 95% confidence interval (5.4, 28.8) and a p value for difference between groups of < 0.001. The incidence rate per 100 child-years of observation during the first 36 months of life was 11.3 for HIV-infected, 1.1 for uninfected, and 0.5 for control children. Clinical and laboratory variables were not useful in identifying HIV-infected children at risk for pneumococcal disease. CONCLUSION Practical strategies to prevent pneumococcal disease among HIV-infected children need to be developed.

Exposure to Environmental Risk Factors and Parenting Attitudes Among Substance-Abusing Women

This study examined the amount of exposure to negative environmental risks and their association with parenting attitudes among a group of inner city substance-abusing women. Mothers (N = 198) were recruited at delivery and were part of a randomized longitudinal intervention study for substance-abusing women and their infants. When the infants were 18 months old, a cumulative environmental risk score was calculated for each mother based on nine factors: violence (both domestic and environmental), depression, homelessness, incarceration, number of children, life stress, psychiatric problems, and absence of significant other. Based on their cumulative scores, mothers were placed in a low (N = 106) or high environmental risk group (N = 92). Mothers in the high-risk group had fewer years of education and were younger when their first child was born. Multivariate analyses indicate that mothers in the high-risk group had significantly worse scores on parenting attitude scales. Given the current state of welfare reform, it is important to determine which factors besides maternal substance abuse place these mothers at risk for poor parenting.

Mother–Infant Interaction: Effects of a Home Intervention and Ongoing Maternal Drug Use

Examined the effects of a home-based intervention on mother-infant interaction among drug-using women and their infants. At 2 weeks postpartum, mothers and infants were randomly assigned to either an intervention (n = 84) or a control (n = 87) group. Control families received brief monthly tracking visits, and intervention families received weekly visits by trained lay visitors. Mother-infant interaction was evaluated at 6 months through observation of feeding. Although there were no direct effects of the intervention, in the control group, mothers who continued to use drugs were less responsive to their babies than mothers who were drug free. In the intervention group, drug use was not associated with maternal responsiveness. Weekly home-based intervention may be a protective strategy for children of drug-using women because it disrupts the relation between ongoing maternal drug use and low maternal responsiveness.

Characteristics of children referred because of hyperactivity

Data are presented on 100 children who were referred to an interdisciplinary diagnostic and evaluation clinic because of “hyperactivity”. each child received a thorough medical and psychologic examination; electroencephalograms were done on 78 of the children. A total of 299 independent observations of behavior were made (average 3 per child), and in only 75 (25 per cent) of these was the child being examined judged to be excessively active. Of the 100 children, 13 were rated as hyperactive by all observers and 58 were judged not to be overly active by any of the staff. It is concluded that hyperactivity is an ill-defined and inconstant phenomenon commonly associated with organic and/or developmental defects coupled with unfavorable environmental influences. An evaluation of the data reveals no significant relationship among the neurological examination, electroencephalogram, and final diagnosis. Extensive medical evaluations of children referred because of “hyperactivity” are relatively unrewarding.

Neonatal Outcome in Infants With Evidence of Fetal Exposure to Opiates, Cocaine, and Cannabinoids:

This study evaluated the neonatal outcome of infants with evidence of fetal exposure to cocaine, opiates, and cannabinoids. Subjects were from the newborn nursery of an inner-city university teaching hospital. Meconium from 141 infants admitted to the full-term nursery was analyzed for metabolites of opiates, cocaine, and cannabinoids. The population was 72% African-American; 82% had medical assistance; history of drug use was reported in the medical records in 18%; mean maternal age was 24.2 years; mean birth weight was 3,234 ± 502 g; and neonatal abstinence syndrome was reported in 7%. Meconium analysis data showed the following: 52.5% were drug-free; cocaine was present in 31 %, opiates in 18% (cocaine and/or opiates 39%), and cannabinoids in 17%. In 38 infants in whom urine toxicology was obtained for clinical indications, meconium was more sensitive than urine in detecting drug exposure (55.3% vs 31.5%). There was no significant difference between cocaine/opiate-exposed and drug-free infants in race, socioeconomic status, maternal age, birth weight, head circumference, length, and Apgar scores. Cocaine/opiate-exposed infants had greater length of stay and increased frequency of maternal sexually transmitted diseases during pregnancy, with a trend toward a higher percent with fetal distress.

Detection of salivary immunoglobulin A antibodies to HIV-1 in infants and children.

Secretory immunoglobulin A (slgA) antibodies of non-maternal origin are present in newborns and slgA to HIV-1 antigens has been detected in infected adults. In this study we investigated the presence of HIV-1-specific IgA in saliva from 41 children (aged 1 day–46 months) born to women at risk for HIV-1 infection. Saliva samples were assayed for HIV-1 antibodies with IgA-specific Western blot. The samples from 10 out of 11 children with subsequently proven infection, including one aged 6 months, demonstrated IgA antibodies to HIV-1 envelope antigens. Samples from infants under 15 months, who were born to infected mothers and subsequently shown to be uninfected, were slgA negative. Of the 12 children with continued indeterminate HIV-1 status, eight showed neither slgA nor serologic evidence of infection and four showed slgA antibodies. HIV-1-specific slgA was detectable before the age of 15 months and may prove to be valuable in the diagnosis of HIV-1 infection in infants.

The Effect of Prenatal Drug Exposure and Caregiving Context on Children’s Performance on a Task of Sustained Visual Attention

Objectives: Three groups of children from low-income, urban environments were examined to determine the effects of prenatal drug exposure (PDE) and caregiving environment on sustained visual attention (SVA) at 7 years of age. Methods: Drug-exposed children remaining in maternal care (n = 43), drug-exposed children placed in nonmaternal care (n = 45), and community comparison (CC) children (n = 56) were administered a battery of neurocognitive tests, including the Conners’ Continuous Performance Test (CPT). Results: PDE children remaining in maternal care displayed more omission errors than CC children. PDE children in nonmaternal care had intermediate scores that did not differ significantly from PDE children in maternal care or CC children. There were no group differences with respect to commission errors or reaction time. CPT errors of omission and commission were significantly correlated with parent-reported attention problems and academic achievement scores. Conclusions: PDE in the context of care provided by a maternal caregiver with persistent drug use patterns may contribute to problems in children’s SVA at school-age. As parental drug abuse can interfere with the provision of early care, children raised in a drug-using context may be highly vulnerable to problems with self-regulation, including sustained attention. SVA problems may contribute to subsequent academic and behavioral problems as demands for concentration and sustained effort increase throughout childhood. Children who have been prenatally exposed to drugs or raised in a drug-using household may benefit from early intervention services to avoid problems in SVA that may interfere with subsequent neurocognitive functioning and academic performance.