# Presentation: 525182

## A Clinical Outcome Study of Meth Exposed Infants

- Rizwan Z, Shah, M.D., FAAP
- Blank Children’s Hospital
- Des Moines, Iowa, USA

## 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.

## Referring Agencies

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

## 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.

## 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

## Assessment

- Complete Physical Exam
- Growth Assessment
- Dysmorphology Exam
- Neuromuscular Exam
- Neurobehavioral Assessment
- Developmental Screening

## Conclusion and Recommendations

- Identify areas of concern
- Identify community resources for interventions
- Parent/caregiver education
- Follow up recommendations

## 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.

## 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

## 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.

## PREGNANCY OUTCOME

- 	                         _Meth_ _group_       _Cocaine_ _group_        _Meth_/_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%

## INFANT OUTCOME

- _Growth:_	      _Meth_ _exposed_   _Cocaine_ _exposed_    _Meth_/_Cocaine_
- Weight<10%      19%                     30%                    33%
- Head size<10%   10%                     20%                   40%
- Height value not effected in these groups.

## INDICATORS OF CHILD WELL BEING

-                                 _Meth_ _only_       _Cocaine_        _Meth/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%

## DEVELOPMENTAL OUTCOME

- _Dev delays_ 	   _Meth exposed_	_Cocaine exposed_  _Cocaine/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%

## 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

## 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

## Symptoms of Meth Exposed Infants and Children (III)

- Six Months to Eighteen Months:
- The Honeymoon Phase
- Symptom Free Period

## 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