morphine and Developmental-Disabilities

Fetal alcohol spectrum disorder (FASD) is the most common cause of neurobehavioural handicap in North America. Screening for FASD may facilitate diagnosis and hence management of these children. We present a variety of screening tools for the identification of children at risk for FASD.. We critically reviewed and evaluated published and practiced methods for their potential of screening suspected cases, their epidemiological characteristics (sensitivity, specificity, positive and negative predictive values) [Phase I], as well as their feasibility [Phase II].. The following five tools were selected for the FASD screening toolkit: screening fatty acid ethyl esters in neonatal meconium, the modified Child Behaviour Checklist, Medicine Wheel tool, Asante Centre Probation Officer Tool, and maternal history of drinking and drug use.. The toolkit for FASD screening aims at screening different populations, from the newborns to youth and at-risk mothers. It is anticipated that the toolkit will facilitate diagnosis of FASD.

Topics: Alcohol Drinking; Alcoholism; Biomarkers; Canada; Child; Child Behavior Disorders; Developmental Disabilities; Diagnosis, Differential; Esters; Fatty Acids; Female; Fetal Alcohol Spectrum Disorders; Humans; Infant, Newborn; Mass Screening; Meconium; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Substance Abuse Detection

To determine the relationship between fatty acid ethyl esters (FAEE) in meconium and neurodevelopment in infants exposed to alcohol in utero at 6.5 months, 1 year, and 2 years of age.. A secondary analysis of a prospective cohort of mothers at high risk and their infants recruited after admission to a labor and delivery unit. Mothers were screened for drug and alcohol use during pregnancy by clinical interview and urine screening. Meconium was analyzed for FAEE in 216 newborn infants. Outcome measures included the Bayley Scales of Infant Development Mental (MDI) and Psychomotor (PDI) Developmental Index scores in infants at 6.5 months, 1 year, and 2 years of age.. After controlling for prenatal visits and maternal factors, increasing concentrations of FAEE were significantly associated with poorer mental and psychomotor development (beta +/- standard error) at all follow-up visits: ethyl myristate (MDI -2.46 +/- 1.24, P = .05; PDI -3.88 +/- 1.67, P = .02), ethyl oleate (MDI -1.94 +/- 0.65, P < .01; PDI -2.60 +/- 0.93, P < .01), ethyl linoleate (MDI -1.92 +/- 0.60, P < .01; PDI -2.28 +/- 0.84, P < .01), ethyl linolenate (MDI -1.99 +/- 0.74, P < .01; PDI -2.98 +/- 1.04, P < .01), and ethyl arachidonate (MDI -2.40 +/- 1.11, P = .03; PDI -3.32 +/- 1.51, P = .03).. FAEE in meconium may be a marker for identifying newborns at risk for neurodevelopmental delay from alcohol exposure in utero.

Topics: Arachidonic Acids; Child, Preschool; Developmental Disabilities; Follow-Up Studies; Humans; Infant; Linoleic Acids; Linolenic Acids; Meconium; Myristates; Oleic Acids; Palmitic Acids; Prognosis; Prospective Studies; Psychomotor Performance

Maternal use of cocaine during pregnancy remains a significant public health problem, particularly in urban areas of the United States and among women of low socioeconomic status. Few longitudinal studies have examined cocaine-exposed infants, however, and findings are contradictory because of methodologic limitations.. To assess the effects of prenatal cocaine exposure on child developmental outcomes.. Longitudinal, prospective, masked, comparison birth cohort study with recruitment in 1994-1996.. Obstetric unit of a large US urban teaching hospital.. Four hundred fifteen consecutively enrolled infants (218 cocaine-exposed and 197 unexposed) identified from a high-risk, low-socioeconomic status, primarily black (80%) population screened through clinical interview and urine and meconium samples for drug use. The retention rate was 94% at 2 years of age.. The Bayley Mental and Motor Scales of Infant Development, assessed at 6.5, 12, and 24 months of corrected age.. Controlled for confounding variables, cocaine exposure had significant effects on cognitive development, accounting for a 6-point deficit in Bayley Mental and Motor Scales of Infant Development scores at 2 years, with cocaine-exposed children twice as likely to have significant delay (mental development index <80) (odds ratio, 1.98; 95% confidence interval, 1.21-3.24; P =.006). For motor outcomes, there were no significant cocaine effects.. Cocaine-exposed children had significant cognitive deficits and a doubling of the rate of developmental delay during the first 2 years of life. Because 2-year outcomes are predictive of later cognitive outcomes, it is possible that these children will continue to have learning difficulties at school age.

Topics: Apgar Score; Birth Weight; Cocaine-Related Disorders; Cognition; Developmental Disabilities; Female; Gestational Age; Humans; Infant; Longitudinal Studies; Male; Meconium; Neuropsychological Tests; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Psychomotor Performance; Socioeconomic Factors; Statistics, Nonparametric

One year's experience with MAS in a neonatal intensive-care unit is analyzed with follow-up information. Seventeen patients or 3.7% of all admissions had MAS. Four patients (23.5%) died of acute respiratory failure. Two patients with MAS and persistence of the fetal circulation required cardiac catheterization to exclude cyanotic congenital heart disease. No survivors had persistent chronic lung disease. However, two of three patients with MAS and seizures had significant psychomotor retardation at follow-up examination.

Topics: Amniotic Fluid; Developmental Disabilities; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Inhalation; Meconium; Oxygen Inhalation Therapy; Pneumonia, Aspiration; Pregnancy; Prognosis; Radiography; Respiratory Distress Syndrome, Newborn; Syndrome