Willis A. Wingert

Differences between Dropouts and Active Participants in a Pediatric Clinic for Substance Abuse Mothers

We compared the maternal and birth characteristics of 87 first-year dropouts with 103 active participants of a pediatric clinic which provides long-term follow-up care to offspring exposed in utero to substance abuse mothers. The age, ethnicity, and marital status of the mother; the type of drug used during pregnancy; and the length, gender, number, and type of addiction problems of the newborn were not significantly different between the two groups. However, the dropouts differed significantly from the active participants in many other aspects. More dropout mothers received no prenatal care and did not have children at home at the time of the present birth. More of them were smokers; had gonorrhea, heart, and kidney problems; and had infections complicating their pregnancy. The dropout newborns were found to have lower birthweight and shorter gestation. These clinical parameters defined a suboptimal group of mothers and children requiring more attention and care. The findings also alert investigators of long-term follow-up studies to be aware of basic differences between nonparticipants and participants.

What happens to babies exposed to phencyclidine (PCP) in utero

Fifty-seven infants exposed to phencyclidine (PCP) in utero were followed for the first year of life. Thirty-six (65%) of the 55 for whom birth records were available manifested symptoms of neonatal narcotic withdrawal syndrome, including 16 (52%) of those whose mothers denied opiate abuse during pregnancy. Temperament problems were noted in 47% of the babies and sleep problems in 14%. The majority of infants grew normally, but a larger than expected number started out small and remained small. Testing using the Bayley Scales of Infant Development at age one year revealed a mental development index (mean +/- SD) of 94 +/- 10 and a psychomotor development index of 98 +/- 10. Attachment behavior was abnormal in 17%. Most infants were cared for by their natural mother. Further studies are needed to determine later effects of in utero PCP exposure, as well as effects on the infants being raised by women who have used PCP. Phencyclidine toxicity needs to be considered when evaluating babies with signs of neonatal narcotic withdrawal syndrome.

Attachment interaction behavior between young teenage mothers and their infants.

Behavioral interaction between teenage mothers and their infants was explored. Twenty-six (low income level) Hispanic teenage mothers (mean age 15 years) and their infants (mean age 13.5 months) were compared with an older control group of 30 mothers (mean age 26 years) and their infants (mean age 14.0 months). Infant attachment, exploration, and stress-adaptation behaviors and maternal ability to contact, encourage, and comfort the infant were evaluated. Twenty-six percent of the control infants showed limited ability to cope with stress compared to 47% of infants of teenage mothers. Control mothers differed significantly from teenage mothers in effective eye, verbal, physical contact, and smiling behaviors. These findings suggest that limited teenage maternal behaviors may potentially have a negative psychologic effect for both infants and their young mothers.

Barium enema: an outpatient procedure in the early diagnosis of acute appendicitis.

Both of our patients, young girls with ulcerative colitis, developed the onset of fever, vomiting, and bloody diarrhea after the ingestion of SAS. We believe that these symptoms were not secondary to the underlying ulcerative colitis because they were reproducible in each patient and resolution was more rapid than could be expected with ulcerative colitis. Patient 1 presented with symptoms characteristic of ulcerative colitis. When treated with SAS her condition deteriorated and did not improve until the SAS was discontinued. Symptoms returned during two subsequent challenges although she was clinically well on both occasions and in complete remission on one. Similarly Patient 2 developed symptoms each time she was treated with SAS. Her colitis was quiescent at the time of each challenge. Both patients tolerate aspirin without evidence of gastrointestinal bleeding or upset. Numerous side effects have been reported with both sulfonamides and salicylates, but the combination of fever, vomiting, and bloody diarrhea has not been among them 8. 9 nor has bloody diarrhea been previously reported with SAS. 1~ We have no explanation for the toxicity observed in our patients. Physicians caring for patients with inflammatory bowel disease should be aware that the onset of fever, vomiting, and bloody diarrhea may be due to SAS and not to a flare-up of the disease. REFERENCES 1. Misiewicz J J, Lennard-Jones JE, Connell AM, Baron JH, and Avery Jones F: Controlled trial of sulfasalazine in maintenance therapy for ulcerative colitis, Lancet 1:185, 1965. 2. Goldman P, and Peppercorn MA: Sulfasalazine, N Engl J Med 293:20, 1975. 3. Das KM, Eastwood MA, McManus JPA, and Sircus W: Adverse reaction during salicylazosulfapyridine therapy and the relation with drug metabolism and acetylator phenotype, N Engl J Med 289:491, 1973. 4. Block MB, Genant HK, and Kirsner JB: Pancreatitis as an adverse reaction to salicylazosulfapyridine, N Engl J Med 282:380, 1970. 5. Lead Article. Sulfasalazine induced lung disease, Lancet 2:504, 1974. 6. Wallace IW: Neurotoxicity associated with a reaction to sulfasalazine, Practitioner 204:850, 1970. 7. Strom J: Toxic epidermal necrolysis (Lyells Syndrome) Scand J Infect Dis 1:209, 1969. 8. Woodbury DM, and Fingl E: Analgesic, antipyretics, antiinflammatory agents and drugs employed in the therapy of gout, in Goodman A, and Gilman AG, editors: The pharmacological basis of therapeutics, New York, 1975, The Macmillan Company, pp 325-358. 9. Weinstein LS: Antimicrobial agents, sulfonamides and trimethoprimsulfmethoxazole, in Goodman A, and Gilman AG, editors: The pharmacologic basis of therapeutics, New York, 1975, The Macmillan Company, pp 1113-1129. 10. Schinagl EF: Pharmacia Laboratories Inc., Personal communication.

Distribution and pathology of copperhead (Agkistrodon contortrix) venom

Abstract Rats injected i.p. or i.m. with varying doses of tagged Agkistrodon contortrix venom showed the largest amounts of venom in the kidney and liver at 24 hr, with a slightly different distribution for other organs, and the smallest amounts in the brain and spinal cord. However, the rats injected i.m. showed the highest level at the site of the injection. Edema was seen in both the s.c. and muscle tissues of the rats given the venom i.m., and focal hemorrhage was observed in rats receiving 25 mg/kg or more of venom.

Coma from alcohol sponging

A 30-month-old child who became comatose following sponging with rubbing alcohol was successfully managed with gastric lavage, 10% dextrose in normal saline, and Isolyte in 10% dextrose. All aliphatic alcohols are central nervous system depressants. Reported serum levels have been between 125–200 mg/100 cc and include both fatalities and self-limited comas. In a discussion of the pathophysiology, it is pointed out that high concentrations of isopropyl alcohol and ethanol can result in cardiac arrest or severe hypotension. Liver damage is common. Treatment includes intensive care with intravenous fluids, temperature control, respiratory assistance, transfusion, gastric lavage, and dialysis.

Effect of a rattlesnake venom (Crotalus viridis helleri) on bone marrow

Crotalus viridis helleri venom produces a fall in peripheral platelet count in rats but does not appear to damage the precursors in the bone marrow. The major response is a myeloid hyperplasia.

PNPs in Follow-Up Care Of High-Risk Infants

Among infants born with a weight of less than 1,500 gm. during the 1950s, 50 percent or more subsequently were found to have significant physical, neurological, or developmental handicaps(1-3). Improved survival rates in this highrisk group create a need for reliable, long-term data to evaluate the prevalence of significant problems. Through development of a model project with a pediatric nurse practitioner giving primary care and as patient advocate, we hoped to accomplish two goals: 1. To develop a follow-up program with continuity of care that would improve patient-professional relationships and patient satisfaction, compliance, and follow-up. 2. To evaluate the neurological, physical, and developmental status of high-risk infants of low birth weight and the relationship of this status to changes in perinatal

DECLINE IN MENTAL DEVELOPMENT AND INFANT-MOTHER ATTACHMENT SCORES IN INFANTS OF SUBSTANCE ABUSE MOTHERS

A cohort of 24 physically and neurologically normal infants followed in a special pediatric clinic designed for care of off-spring of substance abusing mothers† was evaluated at ages 1 and 2 years with the Bayley Scales of Infant Development and with a modification of the Ainsworth-Bell Infant-Mother Attachment Scale. The 11 male and 13 female infants were from a low income Hispanic background. Mean Bayley Mental Scores (MDI) declined from 95.5 at 1 year to 87.3 at 2 years. At 1 year of age 80% of children had normal MDI scores (mean=95.5) and 20% had suspect scores (mean=83.0). When re-tested at age 2, 67% were normal (mean=87.3), 29% were suspect (mean=80.8) and 1 female infant was abnormal (67.0). Of the 7 infants with suspect scores, 5 were male and 2 were female. When infant-mother attachment behavior was evaluated at 1 year, 83% were found to be normal, 17% suspect or abnormal. Normal second year attachment behavior was found in 71% of the sample with 29% suspect or abnormal. All 7 children with suspect/abnormal attachment behavior at 2 years showed a decline in mental score from the first year. Four of these had fallen from normal to suspect category. In summary, infants of substance abuse mothers showed a decline in Bayley mental scores and a decline in appropriate attachment behavior over the first 2 years. Test results suggest that male infants may be more vulnerable to this decline. Health providers must recognize that these families need long term support. †Herion, PCP, polydrugs.

98 EFFECTIVENESS OF CONTACT BEHAVIORS IN STRESS REDUC TION BY HIGH-RISK INFANT MOTHERS WITH THEIR YEAR OLD INFANTS

Questions have been raised concerning the long range effects of interference with healthy bonding and attachment between high risk mother-infant dyads. A tool observing maternal behaviors of high risk mother/infant dyads (mothers of infants with BW <1500 gm N 69 and teenage mothers N 26) in a set situation was evaluated and the results compared with a control group of 30 mothers of normal infants. All mother/infant dyads had the same ethnic and socioeconomic background. Mothers were observed for response to their infants by sensory contact behaviors directed to releasing infant stress. Visual, verbal, physical contact and facial expression were evaluated. Test results showed that maternal contact resulting in infant stressing reduction was reduced in all areas described above for teenage mothers and mothers of LBW infants when compared to control mothers. Only 7.8% of teenage mothers gave verbal support to their infants compared with 35% of LBW infant mothers and 78% of control mothers. Warm physical contact was evidenced by 4% of teenage mothers compared with 19.3% for LBW infant/mothers and 28.3% for the control group. The study results indicate decreased effective maternal stress reducing behaviors in high risk mothers when compared with normal controls. This was more marked in teenage mothers than LBW infant mothers.